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IntroductionSperm cryopreservation is a valuable technique for storing valuable canine genetics. However, little is known concerning the fate of frozen sperm stored in a sperm bank. This study aimed to characterize dogs presented for sperm cryopreservation and describe the use and popularity of frozen sperm in the Netherlands and Belgium over recent years.MethodsMedical records from dogs presented for sperm cryopreservation between January 1, 2014 and December 31, 2022 at two different freezing centers were reviewed retrospectively. Imported frozen sperm was excluded due to lack of usage information. Each sperm cryopreservation was considered a single event, and data were collected separately for each cryopreserved sample.ResultsA total of 3,090 ejaculates from 1,040 males of 157 different breeds were included and investigated using exploratory data analysis. The findings showed a steady rise in the popularity of sperm cryopreservation, with annual growth rates ranging from 8.4 to 41.9%. The majority of dogs (88.5%) were between 1 and 9 years old at the time of sperm cryopreservation, with nearly one-third aged 2–4 years. Most dogs were collected for sperm cryopreservation once (62.8%) or twice (21.6%). Sperm banks were used for both short- and long-term storage needs, and 6.83% of ejaculates were eventually discarded. The primary use of froze sperm was for international shipment, while 21.8% was used locally for artificial insemination. Depending on the year of cryopreservation, between 44.1 and 79.6% of frozen ejaculates remained unused or only partially used at the time of data collection.DiscussionThe results of this study provides the first comprehensive analysis of the use and popularity of frozen sperm among dog breeders in Belgium and the Netherlands and suggest a change in breeding practices in recent years. The percentage of breeders resorting to sperm cryopreservation and the extent of frozen sperm use in current breeding strategies remain to be defined in future studies.

Abstract Background Asthma is a common disease characterized by chronic inflammation of the lower airways, bronchial hyperactivity, and (reversible) airway obstruction. The Global Initiative of Asthma Guideline recommends a flowchart to diagnose asthma with first-step spirometry with reversibility and a bronchial challenge test (BPT) with histamine or methacholine as a second step [1]. The BPT is considered burdensome, time-consuming for patients and staff, can cause side effects, and is expensive. In addition, this test strongly encumbers lung function capacity. Elevated Nitric Oxide (NO) is associated with airway eosinophilic inflammation in asthma patients and can be measured in exhaled air with the Fractional exhaled (Fe) NO-test. This low-burden FeNO-test could be used as an ‘add-on’ test in asthma diagnostics [2, 3]. Methods and analysis This multi-center prospective study (Trial number: NCT06230458) compares the ‘standard asthma diagnostic work-up’ (spirometry with reversibility and BPT) to the ‘new asthma diagnostics work-up’ (FeNO-test as an intermediate step between the spirometry with reversibility and the BPT), intending to determine the impact of the FeNO-based strategy, in terms of the number of avoided BPTs, cost-effectiveness and reduced burden to the patient and health care. The cost reduction of incorporating the FeNO-test in the new diagnostic algorithm will be established by the number of theoretically avoided BPT. The decrease in burden will be studied by calculating differences in the Visual Analogue Scale (VAS) -score and Asthma Quality of Life Questionnaire (AQLQ) -score after the BPT and FeNO-test with an independent T-test. The accuracy of the FeNO-test will be calculated by comparing the FeNO-test outcomes to the (gold standard) BPTs outcomes in terms of sensitivity and specificity. The intention is to include 171 patients. Ethics and dissemination The local medical ethics committee approved the proposed study and is considered a low-burden and risk-low study. The local medical ethics committee registration number: R23.005. Strengths and limitations of this study Strengths: This is the first study that investigates the value of the FeNO-test (cut off ≥ 50 ppb) as an add-on test, to determine the impact of the FeNO-based strategy, in terms of the number of avoided BPTs, cost-effectiveness, and reduced burden on the patient and health care. Limitations: High FeNO levels may also be observed in other diseases such as eosinophilic chronic bronchitis and allergic rhinitis. The FeNO-test can be used to rule in a diagnosis of asthma with confidence, however, due to the poor sensitivity it is not suitable to rule out asthma.

Pieter-Paul Hekking,1 Monique van Meggelen,1 W Johan Lie,2 Rogier Arnaud Sebastiaan Hoek,3,4 Dirk van Ranst,5 Stephan Cornelis Johan van der Kleij,6 Leonard Seghers,4 Jasper Kappen,1,7 Gert-Jan Braunstahl,1,8 Johannes In ’t Veen1 On behalf of Severe Asthma & COPD Network South West Netherlands1Centre of Excellence for Asthma, COPD & Respiratory Allergy, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; 2Department of Pulmonary Medicine, Maasstad Hospital, Rotterdam, the Netherlands; 3Department of Pulmonary Medicine, Bravis Hospital, Bergen op Zoom, the Netherlands; 4Department of Pulmonary Medicine, Erasmus MC Transplant Institute, Rotterdam, the Netherlands; 5Revant, Pulmonary Rehabilitation, Breda, the Netherlands; 6Department of Intensive Care Medicine and Home Mechanical Ventilation, Rotterdam, the Netherlands; 7Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK; 8Department of Pulmonary Medicine, Rotterdam, the NetherlandsCorrespondence: Pieter-Paul Hekking, Franciscus Gasthuis & Vlietland, Centre of excellence for asthma, COPD & Respiratory allergy, Kleiweg, 500, Rotterdam, 3045 PM, the Netherlands, Email p.hekking@franciscus.nl

Abstract Heterogeneity in speech under stress has been a recurring issue in stress research, potentially due to varied stress induction paradigms. This study investigated speech features in semi-guided speech following two distinct psychosocial stress paradigms (Cyberball and MIST) and their respective control conditions. Only negative affect increased during Cyberball, while self-reported stress, skin conductance response rate, and negative affect increased during MIST. Fundamental frequency (F0), speech rate, and jitter significantly changed during MIST, but not Cyberball; HNR and shimmer showed no expected changes. The results indicate that observed speech features are robust in semi-guided speech and sensitive to stressors eliciting additional physiological stress responses, not solely decreases in negative affect. These differences between stressors may explain literature heterogeneity. Our findings support the potential of speech as a stress level biomarker, especially when stress elicits physiological reactions, similar to other biomarkers. This highlights its promise as a tool for measuring stress in everyday settings, considering its affordability, non-intrusiveness, and ease of collection. Future research should test these results' robustness and specificity in naturalistic settings, such as freely spoken speech and noisy environments while exploring and validating a broader range of informative speech features in the context of stress.

The concept of pre-diabetes has led to provision of measures to reduce disease progression through identification of subjects at risk of diabetes. We previously considered the idea of pre-asthma in relation to allergic asthma and considered that, in addition to the need to improve population health via multiple measures, including reduction of exposure to allergens and pollutants and avoidance of obesity, there are several possible specific means to reduce asthma development in those most at risk (pre- asthma). The most obvious is allergen immunotherapy (AIT), which when given for allergic rhinitis (AR) has reasonable evidence to support asthma prevention in children (2) but also needs further study as primary prevention. In this second paper we explore the possibilities for similar actions in late onset eosinophilic asthma.

Background: Intraoperative hypotension has been extensively studied for its association with adverse outcomes. However, small sample sizes and methodological issues limit the causal inference that can be drawn. Methods: In this multicentre, adaptive, randomised controlled trial, we will include 5000 adult inpatients scheduled for elective non-cardiac surgery under general or central neuraxial anaesthesia. Patients will be either randomly allocated to the intervention or care-as-usual group using computer-generated blocks of four, six, or eight, with an allocation ratio of 1:1. In the intervention arm patients will be divided into low-, intermediate-, and high-risk groups based on their likelihood to experience intraoperative hypotension, with resulting mean blood pressure targets of 70, 80, and 90 mm Hg, respectively. Anaesthesia teams will be provided with a clinical guideline on how to keep patients at their target blood pressure. During the first 6 months of the trial the intervention strategy will be evaluated and further revised in adaptation cycles of 3 weeks if necessary, to improve successful impact on the clinical process. The primary outcome is postoperative disability after 6 months measured with the World Health Organization Disability Assessment Score (WHODAS) 2.0 questionnaire. Ethics and dissemination: This study protocol has been approved by the Medical Ethics Committee of the University Medical Centre Utrecht (20–749) and all protocol amendments will be communicated to the Medical Ethics Committee. The study protocol is in adherence with the Declaration of Helsinki and the guideline of Good Clinical Practice. Dissemination plans include publication in a peer-reviewed journal. Clinical trial registration: The Dutch Trial Register, NL9391. Registered on 22 March 2021.

Abstract BackgroundThe posterior Müller muscle-conjunctival resection (MMCR) procedure is a straightforward procedure for the correction of eyelid ptosis with a relatively short operating time and fast recovery. Traditionally, its use was limited to patients with mild involutional ptosis and good levator function and a positive phenylephrine test result. ObjectivesTo evaluate the efficacy of the MMCR procedure as a primary step to treat eyelid ptosis with varying etiology and severity, including patients with more severe ptosis and moderate levator function, and to produce a treatment algorithm. MethodsA retrospective analysis of the results of 34 patients, comprising 56 operated eyelids, treated with the MMCR procedure for eyelid ptotis between 2016 and 2018, was performed. Preoperative and postoperative pictures were analyzed for determining the margin-to-reflex distance (MRD1), symmetry, and complications. ResultsWe found a mean preoperative MRD1 of 1.3 mm (SD 1.1) and postoperative MRD1 of 3.2 mm (SD 1.0). The mean postoperative MRD1 for unilateral and bilateral cases was 3.4 (SD 0.8) and 3.2 (SD 1.1), respectively. Only 2 patients (5.9%) had an asymmetrical postoperative result (>1.0 mm MRD1 difference), and both were unilateral cases. Complications were scarce: only 1 patient (2.9%) developed dry eyes and 2 patients experienced temporary discomfort from the conjunctival sutures. ConclusionsThe MMCR procedure appears to be an excellent procedure as a primary step to correct eyelid ptosis with varying etiologies and severity, due to its low risk of asymmetry, short learning curve, and high success rate. A flow chart as treatment algorithm is provided for clinical decision making. Level of Evidence: 4

Asthma, which affects some 300 million people worldwide and caused 455,000 deaths in 2019, is a significant burden to suffers and to society. It is the most common chronic disease in children and represents one of the major causes for years lived with disability. Significant efforts are made by organizations such as WHO in improving the diagnosis, treatment and monitoring of asthma. However asthma prevention has been less studied. Currently there is a concept of pre- diabetes which allows a reduction in full blown diabetes if diet and exercise are undertaken. Similar predictive states are found in Alzheimer's and Parkinson's diseases. In this paper we explore the possibilities for asthma prevention, both at population level and also investigate the possibility of defining a state of pre-asthma, in which intensive treatment could reduce progression to asthma. Since asthma is a heterogeneous condition, this paper is concerned with allergic asthma. A subsequent one will deal with late onset eosinophilic asthma.

Abstract The usage of EEG to uncover the influence of psychosocial stressors (PSSs) on neural activity has gained significant attention throughout recent years, but the results are often troubled by confounding stressor types. To investigate the effect of PSSs alone on neural activity, we employed a paradigm where participants are exposed to negative peer comparison as PSS, while other possible stressors are kept constant, and compared this with a condition where participants received neutral feedback. We analyzed commonly used sensor level EEG indices (frontal theta, alpha, and beta power) and further investigated whether source level power and functional connectivity (i.e., the temporal dependence between spatially seperated brain regions) measures, which have to our knowledge not yet been used, are more sensitive to PSSs than sensor level-derived EEG measures. Our results show that on sensor level, no significant frontal power changes are present (all p’s > 0.16), indicating that sensor level frontal power measures are not sensitive enough to be affected by only PSSs. On source level, we find increased alpha power (indicative of decreased cortical activity) in the left- and right precuneus and right posterior cingulate cortex (all p’s

Introduction: Maternal diabetes during pregnancy is well known to be associated with a higher risk for structural birth defects in the offspring. Recent searches for underlying mechanisms have largely focused on aberrant processes in the embryo itself, although prior research in rodent models implicated dysfunction also of the visceral yolk sac. The objective of our research was to investigate both tissues within the conceptus simultaneously.Methods: We conducted unbiased transcriptome profiling by RNA sequencing on pairs of individual yolk sacs and their cognate embryos, using the non-obese diabetic (NOD) mouse model. The analysis was performed at gestational day 8.5 on morphologically normal specimen to circumvent confounding by defective development.Results: Even with large sample numbers (n = 33 in each group), we observed considerable variability of gene expression, primarily driven by exposure to maternal diabetes, and secondarily by developmental stage of the embryo. Only a moderate number of genes changed expression in the yolk sac, while in the embryo, the exposure distinctly influenced the relationship of gene expression levels to developmental progression, revealing a possible role for altered cell cycle regulation in the response. Also affected in embryos under diabetic conditions were genes involved in cholesterol biosynthesis and NAD metabolism pathways.Discussion: Exposure to maternal diabetes during gastrulation changes transcriptomic profiles in embryos to a substantially greater effect than in the corresponding yolk sacs, indicating that despite yolk sac being of embryonic origin, different mechanisms control transcriptional activity in these tissues. The effects of maternal diabetes on expression of many genes that are correlated with developmental progression (i.e. somite stage) highlight the importance of considering developmental maturity in the interpretation of transcriptomic data. Our analyses identified cholesterol biosynthesis and NAD metabolism as novel pathways not previously implicated in diabetic pregnancies. Both NAD and cholesterol availability affect a wide variety of cellular signaling processes, and can be modulated by diet, implying that prevention of adverse outcomes from diabetic pregnancies may require broad interventions, particularly in the early stages of pregnancy.

Introduction: Clarifying the effect of music on pain endurance in an experimental design could aid in how music should be applied during both surgical and non-surgical interventions. This study aims to investigate the effect of music on pain endurance and the involvement of the sympathetic adrenomedullary axis (SAM) and the hypothalamic-pituitary-adrenocortical axis (HPA). Materials and methods: In this randomized controlled trial all participants received increasing electric stimuli through their non-dominant index finger. Participants were randomly assigned to the music group (M) receiving a 20-minute music intervention or control group (C) receiving a 20-minute resting period. The primary outcome was pain endurance, defined as amount milliampere tolerated. Secondary outcomes included anxiety level, SAM-axis based on heart rate variability (HRV) and salivary alpha-amylase, and HPA-axis activity based on salivary cortisol. Results: In the intention-to-treat analysis, the effect of music on pain tolerance did not statistically differ between the M and C group. A significant positive effect of music on pain endurance was noted after excluding participants with a high skin impedance (p = 0.013, CI 0.35; 2.85). Increased HRV was observed in the M-group compared to the C-group for SDNN (B/95%CI:13.80/2.22;25.39, p = 0.022), RMSSD (B/95%CI:15.97/1.64;30.31, p = 0.032), VLF (B/95%CI:212.08/60.49;363.67, p = 0.008) and HF (B/95%CI:821.15/150.78;1491.52, p = 0.0190). No statistical significance was observed in other secondary outcomes. Conclusions: The effect of the music intervention on pain endurance was not statistically significant in the intention-to-treat analysis. The subgroup analyses revealed an increase in pain endurance in the music group after correcting for skin impedance, which could be attributed to increased parasympathetic activation.

Introduction: According to the Master Plan 2020, science education will play a critical role in future medical curricula. Science modules have already been implemented at many locations. Other medical faculties will follow in the next few years, as legislation is expected to make recommendations of the national competence-based learning objectives curriculum for medicine (NKLM) mandatory. This article aims to present an implementation example from epidemiology and biometry as a contribution to the didactic discussions within the data sciences in medicine. Project description: We report on our experiences with a data analysis project for second-year medical students, which has been compulsory at the Faculty of Medicine and Health Sciences since 2019. The project is intended to train the scientific skills required from the subjects of epidemiology and biometry for student research projects. Emphasis is placed on responsible data handling, transparency, and reproducibility. For example, the writing of a statistical analysis plan is required prior to data access. Improved standardization of materials, optional use of the English language, and digital support will be implemented to help manage the project when student numbers increase. Discussion: The experience from five years is very positive, although a formal evaluation of the learning success is still pending. Current challenges concern staffing, additional time and supervision requirements for those students who do statistical programming with R, and improved integration into the medical curriculum.

The most accurate measurements of the mass attenuation coefficient for metals at low temperature for the zinc K-edge from 9.5 keV to 11.5 keV at temperatures of 10 K, 50 K, 100 K and 150 K using the hybrid technique are reported. This is the first time transition metal X-ray absorption fine structure (XAFS) has been studied using the hybrid technique and at low temperatures. This is also the first hybrid-like experiment at the Australian Synchrotron. The measured transmission and fluorescence XAFS spectra are compared and benchmarked against each other with detailed systematic analyses. A recent method for modelling self-absorption in fluorescence has been adapted and applied to a solid sample. The XAFS spectra are analysed using eFEFFIT to provide a robust measurement of the evolution of nanostructure, including such properties as net thermal expansion and mean-square relative displacement. This work investigates crystal dynamics, nanostructural evolution and the results of using the Debye and Einstein models to determine atomic positions. Accuracies achieved, when compared with the literature, exceed those achieved by both relative and differential XAFS, and represent a state-of-the-art for future structural investigations. Bond length uncertainties are of the order of 20–40 fm.

Abstract The use of speech as a digital biomarker to detect stress levels is increasingly gaining attention. Yet, heterogeneous effects of stress on specific acoustic speech features have been observed, possibly due to previous studies’ use of different stress labels/categories and the lack of solid stress induction paradigms or validation of experienced stress. Here, we deployed a controlled, within-subject psychosocial stress induction experiment in which participants received both neutral (control condition) and negative (negative condition) comparative feedback after solving a challenging cognitive task. This study is the first to use a (non-actor) within-participant design that verifies a successful stress induction using both self-report (i.e., decreased reported valence) and physiological measures (i.e., increased heart rate acceleration using event-related cardiac responses during feedback exposure). Analyses of acoustic speech features showed a significant increase in Fundamental Frequency (F0) and Harmonics-to-Noise Ratio (HNR), and a significant decrease in shimmer during the negative feedback condition. Our results using read-out-loud speech comply with earlier research, yet we are the first to validate these results in a well-controlled but ecologically-valid setting to guarantee the generalization of our findings to real-life settings. Further research should aim to replicate these results in a free speech setting to test the robustness of our findings for real-world settings and should include semantics to also take into account what you say and not only how you say it.

BackgroundPediatric oncology patients who require admission to the pediatric intensive care unit (PICU) have worse outcomes compared to their non-cancer peers. Although multi-organ dysfunction (MOD) plays a pivotal role in PICU mortality and morbidity, risk factors for MOD have not yet been identified. We aimed to identify risk factors at PICU admission for new or progressive MOD (NPMOD) during the first week of PICU stay.MethodsThis retrospective cohort study included all pediatric oncology patients aged 0 to 18 years admitted to the PICU between June 2018 and June 2021. We used the recently published PODIUM criteria for defining multi-organ dysfunction and estimated the association between covariates at PICU baseline and the outcome NPMOD using a multivariable logistic regression model, with PICU admission as unit of study. To study the predictive performance, the model was internally validated by using bootstrap.ResultsA total of 761 PICU admissions of 571 patients were included. NPMOD was present in 154 PICU admissions (20%). Patients with NPMOD had a high mortality compared to patients without NPMOD, 14% and 1.0% respectively. Hemato-oncological diagnosis, number of failing organs and unplanned admission were independent risk factors for NPMOD. The prognostic model had an overall good discrimination and calibration.ConclusionThe risk factors at PICU admission for NPMOD may help to identify patients who may benefit from closer monitoring and early interventions. When applying the PODIUM criteria, we found some opportunities for fine-tuning these criteria for pediatric oncology patients, that need to be validated in future studies.

Objectives Delirium is a serious complication following neurosurgical procedures. We hypothesise that the beneficial effect of music on a combination of delirium-eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes.Design Prospective randomised controlled trial.Setting Single centre, conducted at the neurosurgical department of the Erasmus Medical Center, Rotterdam, the Netherlands.Participants Adult patients undergoing craniotomy were eligible.Interventions Patients in the intervention group received preferred recorded music before, during and after the operation until day 3 after surgery. Patients in the control group were treated according to standard of clinical care.Primary and secondary outcome measures Primary outcome was presence or absence of postoperative delirium within the first 5 postoperative days measured with the Delirium Observation Screening Scale (DOSS) and, in case of a daily mean score of 3 or higher, a psychiatric evaluation with the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Secondary outcomes included anxiety, heart rate variability (HRV), depth of anaesthesia, delirium severity and duration, postoperative complications, length of stay and location of discharge.Results We enrolled 189 patients (music=95, control=94) from July 2020 through September 2021. Delirium, as assessed by the DOSS, was less common in the music (n=11, 11.6%) than in the control group (n=21, 22.3%, OR:0.49, p=0.048). However, after DSM-5 confirmation, differences in delirium were not significant (4.2% vs 7.4%, OR:0.47, p=0.342). Moreover, music increased the HRV (root mean square of successive differences between normal heartbeats, p=0.012). All other secondary outcomes were not different between groups.Conclusion Our results support the efficacy of music in reducing the incidence of delirium after craniotomy, as found with DOSS but not after DSM-5 confirmation, substantiated by the effect of music on preoperative autonomic tone. Delirium screening tools should be validated and the long-term implications should be evaluated after craniotomy.Trial registration number Trialregister.nl: NL8503 and ClinicalTrials.gov: NCT04649450.

The quantum Boltzmann machine (QBM) is a generative machine learning model for both classical data and quantum states. Training the QBM consists of minimizing the relative entropy from the model to the target state. This requires QBM expectation values which are computationally intractable for large models in general. It is therefore important to develop heuristic training methods that work well in practice. In this work, we study a heuristic method characterized by a nested loop: the inner loop trains the β -variational quantum eigensolver ( β -VQE) by Liu et al (2021 Mach. Learn.: Sci. Technol. 2 025011) to approximate the QBM expectation values; the outer loop trains the QBM to minimize the relative entropy to the target. We show that low-rank representations obtained by β -VQE provide an efficient way to learn low-rank target states, such as classical data and low-temperature quantum tomography. We test the method on both classical and quantum target data with numerical simulations of up to 10 qubits. For the cases considered here, the obtained QBMs can model the target to high fidelity. We implement a trained model on a physical quantum device. The approach offers a valuable route towards variationally training QBMs on near-term quantum devices.

Hox genes encode transcription factors whose roles in patterning animal body plans during embryonic development are well-documented. Multiple studies demonstrate that Hox genes continue to act in adult cells, in normal differentiation, in regenerative processes, and, with abnormal expression, in diverse types of cancers. However, surprisingly little is known about the regulatory mechanisms that govern Hox gene expression in specific cell types, as they differentiate during late embryonic development, and in the adult organism. The murine Hoxc8 gene determines the identity of multiple skeletal elements in the lower thoracic and lumbar region and continues to play a role in the proliferation and differentiation of cells in cartilage as the skeleton matures. This study was undertaken to identify regulatory elements in the Hoxc8 gene that control transcriptional activity, specifically in cartilage-producing chondrocytes. We report that an enhancer comprising two 416 and 224 bps long interacting DNA elements produces reporter gene activity when assayed on a heterologous transcriptional promoter in transgenic mice. This enhancer is distinct in spatial, temporal, and molecular regulation from previously identified regulatory sequences in the Hoxc8 gene that control its expression in early development. The identification of a tissue-specific Hox gene regulatory element now allows mechanistic investigations into Hox transcription factor expression and function in differentiating cell types and adult tissues and to specifically target these cells during repair processes and regeneration.

BackgroundCritical congenital heart disease (cCHD)—requiring cardiac intervention in the first year of life for survival—occurs globally in 2-3 of every 1000 live births. In the critical perioperative period, intensive multimodal monitoring at a pediatric intensive care unit (PICU) is warranted, as their organs—especially the brain—may be severely injured due to hemodynamic and respiratory events. These 24/7 clinical data streams yield large quantities of high-frequency data, which are challenging in terms of interpretation due to the varying and dynamic physiology innate to cCHD. Through advanced data science algorithms, these dynamic data can be condensed into comprehensible information, reducing the cognitive load on the medical team and providing data-driven monitoring support through automated detection of clinical deterioration, which may facilitate timely intervention. ObjectiveThis study aimed to develop a clinical deterioration detection algorithm for PICU patients with cCHD. MethodsRetrospectively, synchronous per-second data of cerebral regional oxygen saturation (rSO2) and 4 vital parameters (respiratory rate, heart rate, oxygen saturation, and invasive mean blood pressure) in neonates with cCHD admitted to the University Medical Center Utrecht, the Netherlands, between 2002 and 2018 were extracted. Patients were stratified based on mean oxygen saturation during admission to account for physiological differences between acyanotic and cyanotic cCHD. Each subset was used to train our algorithm in classifying data as either stable, unstable, or sensor dysfunction. The algorithm was designed to detect combinations of parameters abnormal to the stratified subpopulation and significant deviations from the patient’s unique baseline, which were further analyzed to distinguish clinical improvement from deterioration. Novel data were used for testing, visualized in detail, and internally validated by pediatric intensivists. ResultsA retrospective query yielded 4600 hours and 209 hours of per-second data in 78 and 10 neonates for, respectively, training and testing purposes. During testing, stable episodes occurred 153 times, of which 134 (88%) were correctly detected. Unstable episodes were correctly noted in 46 of 57 (81%) observed episodes. Twelve expert-confirmed unstable episodes were missed in testing. Time-percentual accuracy was 93% and 77% for, respectively, stable and unstable episodes. A total of 138 sensorial dysfunctions were detected, of which 130 (94%) were correct. ConclusionsIn this proof-of-concept study, a clinical deterioration detection algorithm was developed and retrospectively evaluated to classify clinical stability and instability, achieving reasonable performance considering the heterogeneous population of neonates with cCHD. Combined analysis of baseline (ie, patient-specific) deviations and simultaneous parameter-shifting (ie, population-specific) proofs would be promising with respect to enhancing applicability to heterogeneous critically ill pediatric populations. After prospective validation, the current—and comparable—models may, in the future, be used in the automated detection of clinical deterioration and eventually provide data-driven monitoring support to the medical team, allowing for timely intervention.

Maternal diabetes and obesity in pregnancy are well-known risk factors for structural birth defects, including neural tube defects and congenital heart defects. Progeny from affected pregnancies are also predisposed to developing cardiometabolic disease in later life. Based upon in vitro embryo cultures of rat embryos, it was postulated that nutrient uptake by the yolk sac is deficient in diabetic pregnancies. In contrast, using two independent mouse models of maternal diabetes, and a high-fat diet-feeding model of maternal obesity, we observed excessive lipid accumulation at 8.5 days in the yolk sac. The numbers as well as sizes of intracellular lipid droplets were increased in yolk sacs of embryos from diabetic and obese pregnancies. Maternal metabolic disease did not affect expression of lipid transporter proteins, including ApoA1, ApoB and SR-B1, consistent with our earlier report that expression of glucose and fatty acid transporter genes was also unchanged in diabetic pregnancy-derived yolk sacs. Colocalization of lipid droplets with lysosomes was significantly reduced in the yolk sacs from diabetic and obese pregnancies compared to yolk sacs from normal pregnancies. We therefore conclude that processing of lipids is defective in pregnancies affected by maternal metabolic disease, which may lead to reduced availability of lipids to the developing embryo. The possible implications of insufficient supply of lipids -and potentially of other nutrients-to the embryos experiencing adverse pregnancy conditions are discussed.

Abstract Background Asthma patients with obesity often have a high disease burden, despite the use of high-dose inhaled corticosteroids (ICS). In contrast to asthmatics with normal weight, the efficacy of ICS in patients with obesity and asthma is often relatively low. Meanwhile, patients do suffer from side effects, such as weight gain, development of diabetes, cataract, or high blood pressure. The relatively poor response to ICS might be explained by the low prevalence of type 2 inflammatory patterns (T2-low) in patients with asthma and obesity. T2-low inflammation is characterized by low eosinophilic count, low Fractional exhaled NO (FeNO), no clinically allergy-driven asthma, and no need for maintenance oral corticosteroids (OCS). We aim to study whether ICS can be safely withdrawn in patients with T2-low asthma and obesity while maintaining an equal level of asthma control. Secondary outcomes focus on the prevalence of ‘false-negative’ T2-low phenotypes (i.e. T2-hidden) and the effect of ICS withdrawal on parameters of the metabolic syndrome. This study will lead to a better understanding of this poorly understood subgroup and might find new treatable traits. Methods The STOP trial is an investigator-initiated, multicenter, non-inferiority, open-label, crossover study aiming to assess whether ICS can be safely withdrawn in adults aged 17–75 years with T2-low asthma and obesity (body mass index (BMI) ≥ 30 kg/m2). Patients will be randomly divided into two arms (both n = 60). One arm will start with fixed-dose ICS (control group) and one arm will taper and subsequently stop ICS (intervention group). Patients in the intervention group will remain ICS naïve for ten weeks. After a washout of 4 weeks, patients will crossover to the other study arm. The crossover study takes 36 weeks to complete. Patients will be asked to participate in the extension study, to investigate the long-term metabolic benefits of ICS withdrawal. Discussion This study yields valuable data on ICS tapering in patients with T2-low asthma and obesity. It informs future guidelines and committees on corticosteroid-sparing algorithms in these patients. Trial registration Netherlands Trial Register, NL8759, registered 2020–07-06, https://www.trialregister.nl/trial/8759 . Protocol version and date: version 2.1, 20 November 2020.

IntroductionAwake craniotomy is increasingly used to resect intrinsic brain tumors while preserving language. The level of musical training might affect the speed and extend of postoperative language recovery, as increased white matter connectivity in the corpus callosum is described in musicians compared to non-musicians.MethodsIn this cohort study, we included adult patients undergoing treatment for glioma with an awake resection procedure at two neurosurgical centers and assessed language preoperatively (T1) and postoperatively at three months (T2) and one year (T3) with the Diagnostic Instrument for Mild Aphasia (DIMA), transferred to z-scores. Moreover, patients’ musicality was divided into three groups based on the Musical Expertise Criterion (MEC) and automated volumetric measures of the corpus callosum were conducted.ResultsWe enrolled forty-six patients, between June 2015 and September 2021, and divided in: group A (non-musicians, n = 19, 41.3%), group B (amateur musicians, n = 17, 36.9%) and group C (trained musicians, n = 10, 21.7%). No significant differences on postoperative language course between the three musicality groups were observed in the main analyses. However, a trend towards less deterioration of language (mean/SD z-scores) was observed within the first three months on the phonological domain (A: −0.425/0.951 vs. B: −0.00100/1.14 vs. C: 0.0289/0.566, p-value = 0.19) with a significant effect between non-musicians vs. instrumentalists (A: −0.425/0.951 vs. B + C: 0.201/0.699, p = 0.04). Moreover, a non-significant trend towards a larger volume (mean/SD cm3) of the corpus callosum was observed between the three musicality groups (A: 6.67/1.35 vs. B: 7.09/1.07 vs. C: 8.30/2.30, p = 0.13), with the largest difference of size in the anterior corpus callosum in non-musicians compared to trained musicians (A: 3.28/0.621 vs. C: 4.90/1.41, p = 0.02).ConclusionWith first study on this topic, we support that musicality contributes to language recovery after awake glioma surgery, possibly attributed to a higher white matter connectivity at the anterior part of the corpus callosum. Our conclusion should be handled with caution and interpreted as hypothesis generating only, as most of our results were not significant. Future studies with larger sample sizes are needed to confirm our hypothesis.

Abstract Mendelian genetics poses practical limitations on the number of mutant genes that can be investigated simultaneously for their roles in embryonic development in the mouse. While CRISPR-based gene editing of multiple genes at once offers an attractive alternative strategy, subsequent breeding or establishment of permanent mouse lines will rapidly segregate the different mutant loci again. Direct phenotypic analysis of genomic edits in an embryonic lethal gene in F0 generation mice, or F0 mouse embryos, circumvents the need for breeding or establishment of mutant mouse lines. In the course of genotyping a large cohort of F0 CRISPants, where the embryonic lethal gene T/brachyury was targeted, we noted the presence of multiple CRISPR-induced modifications in individual embryos. Using long-read single-molecule Nanopore sequencing, we identified a wide variety of deletions, ranging up to 3 kb, that would not have been detected or scored as wildtype with commonly used genotyping methods that rely on subcloning and short-read or Sanger sequencing. Long-read sequencing results were crucial for accurate genotype–phenotype correlation in our F0 CRISPants. We thus demonstrate feasibility of screening manipulated F0 embryos for mid-gestation phenotypic consequences of CRISPR-induced mutations without requiring derivation of permanent mouse lines.

Abstract Society suffers from biases and discrimination, a longstanding dilemma that stems from ungrounded, subjective judgments. Especially unequal opportunities in labor remain a persistent challenge, despite the recent inauguration of top-down diplomatic measures. Here we propose a solution by using an objective approach to the measurement of nonverbal behaviors of job candidates that trained for a job assessment. First, we implemented and developed artificial intelligence, computer vision, and unbiased machine learning software to automatically detect facial muscle activity and emotional expressions to predict the candidates’ self-reported motivation levels. The motivation judgments by our model outperformed recruiters’ unreliable, invalid, and sometimes biased judgments. These findings mark the necessity and usefulness of novel, bias-free, and scientific approaches to candidate and employee screening and selection procedures in recruitment and human resources.

The previously undescribed natural product lumnitzeralactone (1), which represents a derivative of ellagic acid, was isolated from the anti-bacterial extract of the Indonesian mangrove species Lumnitzera racemosa Willd. The structure of lumnitzeralactone (1), a proton-deficient and highly challenging condensed aromatic ring system, was unambiguously elucidated by extensive spectroscopic analyses involving high-resolution mass spectrometry (HRMS), 1D 1H and 13C nuclear magnetic resonance spectroscopy (NMR), and 2D NMR (including 1,1-ADEQUATE and 1,n-ADEQUATE). Determination of the structure was supported by computer-assisted structure elucidation (CASE system applying ACD-SE), density functional theory (DFT) calculations, and a two-step chemical synthesis. Possible biosynthetic pathways involving mangrove-associated fungi have been suggested.

Abstract Background There is wide variation in clinical practice for the early detection of prostate cancer, not least because of the ongoing debate about the benefits of prostate-specific antigen (PSA) testing. In this study, we aimed to assess the approaches, attitudes, and knowledge of general practitioners (GPs) regarding PSA testing in primary care in the Netherlands, particularly regarding recommendations for prostate cancer. Methods Questionnaire surveys were sent to 179 GPs in the north-east of the Netherlands, of which 65 (36%) were completed and returned. We also surveyed 23 GPs attending a postgraduate train-the-trainer day (100%). In addition to demographic data and practice characteristics, the 31-item questionnaire covered the attitudes, clinical practice, adherence to PSA screening recommendations, and knowledge concerning the recommendations for prostate cancer early detection. Statistical analysis was limited to the descriptive level. Results Most GPs (95%; n = 82) stated that they had at least read the Dutch GP guideline, but just half (50%; n = 43) also stated that they knew the content. Almost half (46%; n = 39) stated they would offer detailed counseling before ordering a PSA test to an asymptomatic man requesting a test. Overall, prostate cancer screening was reported to be of minor importance compared to other types of cancer screening. Conclusions Clinical PSA testing in primary care in this region of the Netherlands seems generally to be consistent with the relevant guideline for Dutch GPs that is restrictive to PSA testing. The next step will be to further evaluate the effects of the several PSA testing strategies.

Abstract There is increasing scientific interest in the potential association between mindfulness and romantic relationship wellbeing. To date, however, experimental studies using active control groups and testing dyadic effects (i.e. examining both actor and partner effects) are lacking. In the current study, romantically involved individuals engaged for 2 weeks daily in either guided mindfulness exercises, or guided relaxation exercises. Participants, and their partners, completed measures of relationship wellbeing at pre- and post-intervention, and at 1-month follow up. The mindfulness intervention significantly promoted relationship wellbeing, for both participants (i.e. actor effects) and their partners (i.e. partner effects). However, these findings did not significantly differ from changes in relationship wellbeing in the relaxation condition. Theoretical implications of these findings for understanding the association between mindfulness and romantic relationship wellbeing are discussed. Moreover, the findings are discussed in light of recent debates about the relative lack of proper control groups in mindfulness research.

Maternal diabetes in early pregnancy increases the risk for birth defects in the offspring, particularly heart, and neural tube defects. While elevated glucose levels are characteristic for diabetic pregnancies, these are also accompanied by hyperlipidemia, indicating altered nutrient availability. We therefore investigated whether changes in the expression of nutrient transporters at the conception site or in the early post-implantation embryo could account for increased birth defect incidence at later developmental stages. Focusing on glucose and fatty acid transporters, we measured their expression by RT-PCR in the spontaneously diabetic non-obese mouse strain NOD, and in pregnant FVB/N mouse strain dams with Streptozotocin-induced diabetes. Sites of expression in the deciduum, extra-embryonic, and embryonic tissues were determined by RNAscope in situ hybridization. While maternal diabetes had no apparent effects on levels or cellular profiles of expression, we detected striking cell-type specificity of particular nutrient transporters. For examples, Slc2a2/Glut2 expression was restricted to the endodermal cells of the visceral yolk sac, while Slc2a1/Glut1 expression was limited to the mesodermal compartment; Slc27a4/Fatp4 and Slc27a3/Fatp3 also exhibited reciprocally exclusive expression in the endodermal and mesodermal compartments of the yolk sac, respectively. These findings not only highlight the significance of nutrient transporters in the intrauterine environment, but also raise important implications for the etiology of birth defects in diabetic pregnancies, and for strategies aimed at reducing birth defects risk by nutrient supplementation.

Abstract Background Major depressive episode (MDE) is worldwide one of the most prevalent and disabling mental health conditions. In cases of persistent non-response to treatment, electroconvulsive therapy (ECT) is a safe and effective treatment strategy with high response rates. Unfortunately, longitudinal data show low sustained response rates with 6-month relapse rates as high as 50% using existing relapse prevention strategies. Cognitive side effects of ECT, even though transient, might trigger mechanisms that increase relapse in patients who initially responded to ECT. Among these side effects, reduced cognitive control is an important neurobiological driven vulnerability factor for depression. As such, cognitive control training (CCT) holds promise as a non-pharmacological strategy to improve long-term effects of ECT (i.e., increase remission, and reduce depression relapse). Method/design Eighty-eight patients aged between 18 and 70 years with MDE who start CCT will be included in this randomized controlled trial (RCT). Following (partial) response to ECT treatment (at least a 25% reduction of clinical symptoms), patients will be randomly assigned to a computer based CCT or active placebo control. A first aim of this RCT is to assess the effects of CCT compared to an active placebo condition on depression symptomatology, cognitive complaints, and quality of life. Secondly, we will monitor patients every 2 weeks for a period of 6 months following CCT/active placebo, allowing the detection of potential relapse of depression. Thirdly, we will assess patient evaluation of the addition of cognitive remediation to ECT using qualitative interview methods (satisfaction, acceptability and appropriateness). Finally, in order to further advance our understanding of the mechanisms underlying effects of CCT, exploratory analyses will be conducted using video footage collected during the CCT/active control phase of the study. Discussion Cognitive remediation will be performed following response to ECT, and an extensive follow-up period will be employed. Positive findings would not only benefit patients by decreasing relapse, but also by increasing acceptability of ECT, reducing the burden of cognitive side-effects. Trial registration The study is registered with ClinicalTrials.gov . Study ID: NCT04383509 Trial registration date: 12.05.2020.

Abstract Background Estimating the genetic component of a complex phenotype is a complicated problem, mainly because there are many allele effects to estimate from a limited number of phenotypes. In spite of this difficulty, linear methods with variable selection have been able to give good predictions of additive effects of individuals. However, prediction of non-additive genetic effects is challenging with the usual prediction methods. In machine learning, non-additive relations between inputs can be modeled with neural networks. We developed a novel method (NetSparse) that uses Bayesian neural networks with variable selection for the prediction of genotypic values of individuals, including non-additive genetic effects. Results We simulated several populations with different phenotypic models and compared NetSparse to genomic best linear unbiased prediction (GBLUP), BayesB, their dominance variants, and an additive by additive method. We found that when the number of QTL was relatively small (10 or 100), NetSparse had 2 to 28 percentage points higher accuracy than the reference methods. For scenarios that included dominance or epistatic effects, NetSparse had 0.0 to 3.9 percentage points higher accuracy for predicting phenotypes than the reference methods, except in scenarios with extreme overdominance, for which reference methods that explicitly model dominance had 6 percentage points higher accuracy than NetSparse. Conclusions Bayesian neural networks with variable selection are promising for prediction of the genetic component of complex traits in animal breeding, and their performance is robust across different genetic models. However, their large computational costs can hinder their use in practice.

The detection of cancer biomarkers has recently become an established method for the early diagnosis of cancer. The sensitive analysis of specific biomarkers can also be clinically applied for the determination of response to treatment and monitoring of disease progression. Because of the ultra-low concentration of cancer biomarkers in body fluids, diagnostic tools need to be highly sensitive and specific. Conducting polymers (CPs) are particularly known to exhibit numerous features that enable them to serve as excellent materials for the immobilization of biomolecules and the facilitation of electron transfer. Their large surface area, porosity, and the presence of functional groups provide CPs with binding sites suitable for capturing biomarkers, in addition to their sensitive and easy detection. The aim of this review is to present a comprehensive summary of the available electrochemical biosensors based on CPs and their composites for the ultrasensitive detection of selected cancer biomarkers. We have categorized the study based on different types of targeted biomarkers such as DNAs, miRNAs, proteins, enzymes, neurotransmitters and whole cancer cells. The sensitivity of their detection is enhanced by the presence of CPs, providing a limit of detection as low as 0.5 fM (for miRNA) and 10 cells (for the detection of cancer cells). The methods of multiplex biomarker detection and cell capture are indicated as the most promising category, since they furnish more accurate and reliable results. Ultimately, we discuss the available CP-based electrochemical sensors and promising approaches for facilitating cancer diagnosis and treatment.

Inclusive education is a practice of teaching handicapped children in regular classrooms with non-handicapped children to the fullest extent possible; such children may have orthopedic, intellectual, emotional, or visual difficulties or handicaps associated with hearing or learning. In India there are constitutional provisions for Inclusive Education. Education is the right of all children, and IE aims to ensure that all children have access to an appropriate, relevant, affordable and effective education within their community. This education starts in the home with the family, and th includes formal, non-formal and all types of community-based education initiatives. Article 14, Article 21A, The 86 Constitutional Amendment Act 2002 of the Indian Constitution clarifies that "all" includes children with disabilities as well. This article will discuss Concept of inclusive education, Specific Terms in inclusive education such as Impairment, Disability, Special Educational Needs, Learning Difficulty, Mental Handicap, Indian Constitution about Inclusive Education, Reasons For Inclusion, The inclusive education programmes under Sarva Shiksha Abhiyan, Provisions for CWSN (Children With Special Needs) under SSA and a case study on inclusive education.