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The Multicultural Personality Questionnaire (MPQ) is one of the most widely used instruments for measuring individuals' intercultural competences. The original version consists of 91 items, divided into five subscales, and has been shown to predict attitudes, behavior, and outcomes in a variety of intercultural contexts. Recently, a 40-item short form of the MPQ was developed (MPQ-SF), which may be particularly useful in settings in which time or survey space are limited, or where respondent drop-out is likely to occur. For example, the MPQ-SF would be a valuable tool for assessing longitudinal development of multicultural personality traits in training or educational settings. A prerequisite for such research is to establish measurement invariance of the MPQ-SF between different respondent groups, as well as across time points. Using a sample of students in an international university program (n = 519), the present study examines how the scales perform among male and female respondents, between students of Western and Non-Western background, and across two time points, five months apart. Based on our findings, we conclude that all five subscales of the MPQ-SF display sufficient measurement invariance to be reliably used in this and similar contexts, in comparative as well as longitudinal study designs.

IntroductionCardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) and is strongly associated with vascular calcification. An important driver of vascular calcification is high phosphate levels, but these become lower when patients initiate nocturnal hemodialysis or receive a kidney transplant. However, it is unknown whether nocturnal hemodialysis or kidney transplantation mitigate vascular calcification. Therefore, we compared progression of coronary artery calcification (CAC) between patients treated with conventional hemodialysis, nocturnal hemodialysis, and kidney transplant recipients.MethodsWe measured CAC annually up to 3 years in 114 patients with ESRD that were transplantation candidates: 32 that continued conventional hemodialysis, 34 that initiated nocturnal hemodialysis (≥4x 8 hours/week), and 48 that received a kidney transplant. We compared CAC progression between groups as the difference in square root transformed volume scores per year (ΔCAC SQRV) using linear mixed models. Reference category was conventional hemodialysis.ResultsThe mean age of the study population was 53 ±13 years, 75 (66%) were male, and median dialysis duration was 28 (IQR 12-56) months. Median CAC score at enrollment was 171 (IQR 10-647), which did not differ significantly between treatment groups (P = 0.83). Compared to conventional hemodialysis, CAC progression was non-significantly different in nocturnal hemodialysis -0.10 (95% CI -0.77 to 0.57) and kidney transplantation -0.33 (95% CI -0.96 to 0.29) in adjusted models.ConclusionsNocturnal hemodialysis and kidney transplantation are not associated with significantly less CAC progression compared to conventional hemodialysis during up to 3 years follow-up. Further studies are needed to confirm these findings, to determine which type of calcification is measured with CAC in end-stage renal disease, and whether that reflects cardiovascular risk.

Chest radiographs are the most performed radiographic procedure, but suboptimal technical factors can impact clinical interpretation. A deep learning model was developed to assess technical and inspiratory adequacy of anteroposterior chest radiographs. Adult anteroposterior chest radiographs (n = 2375) were assessed for technical adequacy, and if otherwise technically adequate, for adequacy of inspiration. Images were labelled by an experienced radiologist with one of three ground truth labels: inadequate technique (n = 605, 25.5 %), adequate inspiration (n = 900, 37.9 %), and inadequate inspiration (n = 870, 36.6 %). A convolutional neural network was then iteratively trained to predict these labels and evaluated using recall, precision, F1 and micro-F1, and Gradient-weighted Class Activation Mapping analysis on a hold-out test set. Impact of kyphosis on model accuracy was assessed. The model performed best for radiographs with adequate technique, and worst for images with inadequate technique. Recall was highest (89 %) for radiographs with both adequate technique and inspiration, with recall of 81 % for images with adequate technique and inadequate inspiration, and 60 % for images with inadequate technique, although precision was highest (85 %) for this category. Per-class F1 was 80 %, 81 % and 70 % for adequate inspiration, inadequate inspiration, and inadequate technique respectively. Weighted F1 and Micro F1 scores were 78 %. Presence or absence of kyphosis had no significant impact on model accuracy in images with adequate technique. This study explores the promising performance of a machine learning algorithm for assessment of inspiratory adequacy and overall technical adequacy for anteroposterior chest radiograph acquisition. With further refinement, machine learning can contribute to education and quality improvement in radiology departments. [ABSTRACT FROM AUTHOR]

Influencers belong to the daily media diet of many adolescents. As role models, they have the potential to play a crucial role in the identity construction of their viewers. In the age of social media, such role models may now be found more locally – in the same city – and perhaps with more diverse backgrounds. This may be particularly valuable to adolescents growing up in super-diverse cities, as they are surrounded by a multitude of groups and identities during a life phase in which they have to make sense of who they are and where they belong. Despite the heterogeneity of these identities, there is one thing all have in common: the city they live in. With the city as a common framework, local influencers may be important role models for these adolescents, particularly in negotiating their urban identity. This paper aims toward mapping the ways in which social media can play a role in the negotiation of urban identity among youngsters by investigating how YouTube influencers from a super-diverse city are related to each other online, and how their content relates to the (super-diverse) city of Rotterdam. Findings show that in their videos and on their channel pages, influencers mainly affiliate themselves with the city through having the city as the background and context of the videos, through their involvement with cultural trends (e.g., soccer, hip-hop) that link to the city, and through their affiliation with other local influencers. We argue that influencers may therefore provide their viewers with content that may potentially help their local viewers strengthen their urban identity.

Summary: Neural tube defects (NTDs) are common birth defects in humans and show an unexplained female bias. Female mice lacking the tumor suppressor p53 display NTDs with incomplete penetrance. We found that the combined loss of pro-apoptotic BIM and p53 caused 100% penetrant, female-exclusive NTDs, which allowed us to investigate the female-specific functions of p53. We report that female p53−/− embryonic neural tube samples show fewer cells with inactive X chromosome markers Xist and H3K27me3 and a concomitant increase in biallelic expression of the X-linked genes, Huwe1 and Usp9x. Decreased Xist and increased X-linked gene expression was confirmed by RNA sequencing. Moreover, we found that p53 directly bound response elements in the X chromosome inactivation center (XIC). Together, these findings suggest p53 directly activates XIC genes, without which there is stochastic failure in X chromosome inactivation, and that X chromosome inactivation failure may underlie the female bias in neural tube closure defects. : The molecular mechanisms underlying the female bias of neural tube defects are currently unclear. Delbridge et al. present evidence that p53 is required for normal Xist expression and X chromosome inactivation and show in two models that partial failure of X chromosome inactivation is associated with female-biased neural tube defects. Keywords: female-specific neural tube defects, X-chromosome inactivation, p53, Xist, Ftx, Tsix, biallelic expression, BIM, BCL2L11, SMCHD1

In recent years, vaccination rates in the Netherlands have declined slightly, but steadily. The Dutch National Institute for Public Health and the Environment (RIVM) commissioned a Committee for Vaccine Willingness (VWC) to study the societal context of the decline. One of the societal contexts is the Internet, where audiences discuss vaccination and refer to sources of health-related information of varying quality.Working for the VWC, we have explored the Dutch vaccination debate on Twitter in order to: (1) identify online communities in the vaccination debate, (2) identify vaccine-related narratives; and (3) understand how the online communities interact with each other. We identified seven different communities, including (public) health professionals, writers and journalists, anti-establishment, and international vaccination advocates.The debate is spearheaded by the writers & journalists community, while the health- and anti-establishment communities try to influence it. The health community circulates facts, figures and scientific studies, while negative messages about vaccination – either from a homeopathy or conspiracy perspective – are most prevalent in the anti-establishment. The facts and figures shared by the health community hardly reach other communities, whereas the myths introduced by the anti-establishment do spill over to other communities. Our study provides further evidence that negative perceptions about vaccination might be rooted in a wider sentiment of distrust of traditional institutions.We argue that Dutch health organizations should try to address questions, doubts, and worries among the general audience more actively, and present scientific information in a simpler and more attractive way. Keywords: Vaccine hesitancy, Health communication, Social media, Network analysis

ObjectivesOur aim was to describe the numbers and distribution of patients with different types of thalassemia and to assess the standards of care in all thalassemia treatment centers throughout Sri Lanka and the success of the ongoing prevention programme.MethodsThis cross-sectional island-wide survey was conducted by two trained medical graduates, who visited each thalassemia center to collect data from every patient, using a standardized form. Data was collected through review of patient registers and clinical records.ResultsWe collected data on 1774 patients from 23 centers. 1219 patients (68.7%) had homozygous β-thalassemia, 360 patients (20.3%) had hemoglobin E β-thalassemia, and 50 patients (2%) had sickle β-thalassemia. There were unacceptably high serum ferritin levels in almost all centers. The annual number of births of patients with β-thalassaemia varied between 45-55, with little evidence of reduction over 19 years.ConclusionsCentral coordination of the treatment and ultimately prevention of thalassemia is urgently needed in Sri Lanka. Development of expert centers with designated staff with sufficient resources will improve the quality of care and is preferred to managing patients in multiple small units.

In today’s media landscape, audiences increasingly turn to online communities for media consumption and to exchange information about specific niche interests such as health-related topics. This calls for a segmented approach in which interventions are targeted at online communities, tailored to their specific cultures and health-related perceptions, and leverage the dynamics of conversation and social influence in online networks. Strategies drawn from the field of influencer marketing provide interesting opportunities to reach and engage with audiences in a personally relevant manner, including with those who may disagree with an intervention’s message. This article reflects on what health communicators might learn from influencer strategies and proposes digital methods to target and tailor health communication in the digital era. More concretely, we present methods to: (a) identify online communities engaging on a specific health issue; (b) map community specific cultures and health-related perceptions; and (c) identify influencers as potential collaboration partners. As such, we adopt a slightly different take on tailoring by putting the creative and cultural competences of social influencers central, and by aligning our methods with a media mapping protocol to create influencer strategies that are tailored to the cultures and health-related perceptions of multiple online audience segments. We illustrate the potential of these methods with a study of how vaccination is discussed among Dutch Twitter users.

Smchd1 is an epigenetic repressor with important functions in healthy cellular processes and disease. To elucidate its role in transcriptional regulation, we performed two independent genome-wide RNA-sequencing studies comparing wild-type and Smchd1 null samples in neural stem cells and lymphoma cell lines. Using an R-based analysis pipeline that accommodates observational and sample-specific weights in the linear modeling, we identify key genes dysregulated by Smchd1 deletion such as clustered protocadherins in the neural stem cells and imprinted genes in both experiments. Here we provide a detailed description of this analysis, from quality control to read mapping and differential expression analysis. These data sets are publicly available from the Gene Expression Omnibus database (accession numbers GSE64099 and GSE65747). Keywords: RNA-sequencing, voom, Sample variability, Epigenetics

With children using digital media at ever younger ages, media-education becomes a pressing issue for parents. As there is hardly any research on how parents guide the online activities of toddlers and young children an internet-survey was held among 792 Dutch parents of children aged between 2 and 12 years. Factor analysis revealed that for the internet, parents partly use the same strategies they also apply for television and video games: "co-use", "active mediation", and "restrictive mediation". In addition, they also utilise new strategies: "supervision" and "technical safety guidance". Mediation was mainly predicted by the child's age and online behaviour (e.g., gaming, social networking), as well as by the number of computers in the home and the parents' gender, education and computer/internet skills. Finally, parents also use more mediation when they expect that the internet has a positive effect and particularly when they believe that it has a negative impact.

Game studies has seen an increasing interest in serious games with a persuasive goal. Yet, empirical research about the impact of these persuasive games is still limited. This paper aims to advance the field by reporting on an explorative, qualitative study, investigating player experiences in My Life as a Refugee and PeaceMaker, games that address pressing socio-political issues. Theoretically, our research was based on immersion theory and Calleja’s account of player involvement. We conducted in-depth interviews with twelve participants. Our results showed that players experienced the two games in a similar way. With respect to immersion, our results highlight its different aspects by showing that the games’ narratives had the largest impact on feeling immersed. Our participants also experienced ludic, affective, and spatial immersion, which partly deepened their narrative immersion. Finally, we found that perceived realism, narrative depth, and identification contributed to the immersive experience. The major contribution of this paper is showing that immersion heightened participants’ susceptibility to persuasion within the gaming environment, while adding that the roles of emotion and identification in immersion warrant further research.

Summary: We and others have recently reported that the SMC protein Smchd1 is a regulator of chromosome conformation. Smchd1 is critical for the structure of the inactive X chromosome and at autosomal targets such as the Hox genes. However, it is unknown how Smchd1 is recruited to these sites. Here, we report that Smchd1 localizes to the inactive X via the Xist-HnrnpK-PRC1 (polycomb repressive complex 1) pathway. Contrary to previous reports, Smchd1 does not bind Xist or other RNA molecules with any specificity. Rather, the localization of Smchd1 to the inactive X is H2AK119ub dependent. Following perturbation of this interaction, Smchd1 is destabilized, which has consequences for gene silencing genome-wide. Our work adds Smchd1 to the PRC1 silencing pathway for X chromosome inactivation. : Jansz et al. report that the chromatin protein Smchd1 depends on polycomb repressive complex 1-mediated ubiquitylation of histone H2A for its recruitment to the inactive X chromosome and for its protein stability. These data have implications for Smchd1 targeting genome-wide. Keywords: Smchd1, X inactivation, Xist, PRC1, Hnrnpk, Ring1B

BACKGROUND:Health-related quality of life (HRQOL) is an important outcome measure in patients with end-stage renal disease. HRQOL is assumed to improve with kidney transplantation and also with nocturnal hemodialysis compared to conventional hemodialysis. However, there is no evidence regarding HRQOL to support the optimal treatment choice for patients on nocturnal hemodialysis who hesitate opting for transplantation. We therefore compared HRQOL between patients who were treated with kidney transplantation or nocturnal hemodialysis for one year. METHODS:We assessed HQROL using the Kidney Disease Quality of Life-Short Form questionnaire in a cross-sectional sample of patients who were treated with kidney transplantation (n = 41) or nocturnal hemodialysis (n = 31) for one year. All patients on nocturnal hemodialysis were transplantation candidates. Using linear regression, we compared HRQOL between kidney transplantation and nocturnal hemodialysis, and adjusted for age, sex, dialysis duration, cardiovascular disease, and presence of residual urine production. RESULTS:At one year follow-up, mean age of the study population was 54 ±13 years, and median dialysis duration was 3.2 (IQR 2.1-5.0) years. Kidney transplantation was associated with significantly higher HRQOL on the domain "effects" compared to nocturnal hemodialysis (adjusted difference 12.0 points, 95% CI 3.9; 20.1). There were potentially clinically relevant differences between kidney transplantation and nocturnal hemodialysis on the domains "burden" (adjusted difference 11.1 points, 95% CI -2.6; 24.8), "social support" (adjusted difference 6.2, 95% CI -6.6; 19.1), and the physical composite score (adjusted difference 3.0, 95% CI -2.0; 8.1), but these were not significant. CONCLUSIONS:After kidney transplantation, HRQOL is especially higher on the domain "effects of kidney disease" compared to nocturnal hemodialysis. This can be useful when counseling patients on nocturnal hemodialysis who may opt for transplantation.

BACKGROUND:Cardiovascular disease is the leading cause of death in end-stage renal disease and is strongly associated with vascular calcification. Both kidney transplantation and phosphate binders may lower the risk of vascular calcification. Vascular calcification is actively inhibited by vitamin-K-dependent matrix γ-carboxyglutamic acid protein (MGP). Whether kidney transplantation or phosphate binders affect vitamin K status is unknown. Therefore, we studied the influence of kidney transplantation and phosphate binder use on vitamin K status. METHODS:We measured plasma desphospho-uncarboxylated MGP (dp-ucMGP), a marker reflecting low vitamin K status, in a cross-sectional study of patients on hemodialysis (n = 82), peritoneal dialysis (n = 31) or who recently received a kidney transplantation (n = 36). By medication inventory, we assessed phosphate binder use. With linear regression, we assessed the influence of kidney transplantation and phosphate binder use on natural-log-transformed dp-ucMGP, adjusting for potential confounders. RESULTS:Mean age of patients was 52±13 years; 102 (68%) were male. Dp-ucMGP levels were significantly lower in kidney transplant recipients (median 689 pmol/L) compared to patients on dialysis (median 1537 pmol/L, p

Background. We recently reported that frailty is independently predictive of increased mortality in patients with advanced heart failure referred for heart transplantation (HTx). The aim of this study was to assess the impact of frailty on short-term outcomes after bridge-to-transplant ventricular assist device (BTT-VAD) implantation and/or HTx and to determine if frailty is reversible after these procedures. Methods. Between August 2013 and August 2016, 100 of 126 consecutive patients underwent frailty assessment using Fried’s Frailty Phenotype before surgical intervention: 40 (21 nonfrail, 19 frail) BTT-VAD and 77 (60 nonfrail, 17 frail) HTx—including 17 of the 40 BTT-VAD supported patients. Postprocedural survival, intubation time, intensive care unit, and hospital length of stay were compared between frail and nonfrail groups. Twenty-six frail patients were reassessed at 2 months or longer postintervention. Results. Frail patients had lower survival (63 ± 10% vs 94 ± 3% at 1 year, P = 0.012) and experienced significantly longer intensive care unit (11 vs 5 days, P = 0.002) and hospital (49 vs 25 days, P = 0.003) length of stay after surgical intervention compared with nonfrail patients. Twelve of 13 frail patients improved their frailty score after VAD (4.0 ± 0.8 to 1.4 ± 1.1, P < 0.001) and 12 of 13 frail patients improved their frailty score after HTx (3.2 ± 0.4 to 0.9 ± 0.9, P < 0.001). Handgrip strength and depression improved postintervention. Only a slight improvement in cognitive function was seen postintervention. Conclusions. Frail patients with advanced heart failure experience increased mortality and morbidity after surgical intervention with BTT-VAD or HTx. Among those who survive frailty is partly or completely reversible underscoring the importance of considering this factor as a dynamic not fixed entity.

Through an Internet survey of 536 parent-child dyads, the authors researched which mediation strategies parents used to regulate videogaming by their children (8-18 years). Factor analyses revealed that both parents and children distinguished three types of parental mediation: (1) "restrictive mediation", (2) "active mediation", and (3) "co-playing". These strategies are comparable with mediation types that were established in research about television. Comparing the parents' and children's reports it was found that both groups had highly congruent views about the application of mediation. Parental mediation of videogaming was most strongly predicted by the child's age and the parents's game behavior. Furthermore, parents applied more restrictive and active mediation when they feared negative behavioral effects and more often co-played with their children when they expected positive social-emotional effects of gaming. (Contains 6 tables and 1 note.)