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Abstract We introduce a Bayesian genetic algorithm for reconstructing atomic models of monotype crystalline nanoparticles from a single projection using Z-contrast imaging. The number of atoms in a projected atomic column obtained from annular dark field scanning transmission electron microscopy images serves as an input for the initial three-dimensional model. The algorithm minimizes the energy of the structure while utilizing a priori information about the finite precision of the atom-counting results and neighbor-mass relations. The results show promising prospects for obtaining reliable reconstructions of beam-sensitive nanoparticles during dynamical processes from images acquired with sufficiently low incident electron doses.

Tunnel construction in soft soil necessitates a thorough evaluation of soil behavior, embedment depth, ground heaves, and tunnel distortions, especially in earthquake-prone areas. This study presents a numerical parametric investigation of an unconventional tunnel complex formed by combining the closely located twin tunnels. The complex is subjected to varying horizontal ground vibrations, and the influence of lining thickness, embedment depth, and interface conditions on seismic-induced thrusts, shear forces, bending moments, tunnel distortions, and ground heaves is assessed. The applicability of analytical solutions from existing literature for singular tunnels is examined through detailed analyses of different embedment ratios. The study reveals that increased tunnel flexural rigidity leads to higher seismic-induced bending moments in the tunnel complex. Comparison of full-slip and no-slip interface conditions shows that the former exhibits reduced overall tunnel distortions. Furthermore, a comparison is made with a conventional-shaped rectangular tunnel complex. The results indicate that the twin tunnel complex behaves more rigidly under a constant embedment ratio and input motion amplitude. It also results in lower ground heaves and suffers lesser induced lining forces during seismic events, making it a superior performer in comparison. Overall, this research provides valuable insights into the behavior of twin tunnel complexes in soft soil under seismic conditions, showcasing their advantages over conventional shaped tunnels in terms of tunnel distortions, ground heaves, and overall structural response.

A comprehensive cross-national understanding of the classroom learning environment (CLE) is critical to advancing CLE’s development. This study compares the English and Chinese CLE literature to enhance a complete understanding of CLE. We conducted bibliometric analysis on 3,130 English literature from Social Sciences Citation Index (SSCI) and 1,261 Chinese literature from the Chinese Social Sciences Citation Index (CSSCI). The results show that both Chinese and English literature focus on the influence of CLE on students’ cognitive and affective learning outcomes and the incorporation of information technology in CLE. The results also reveal the differences between Chinese and English literature from two perspectives: (1) Chinese CLE research mainly focuses on English education, and English CLE research mainly focuses on science education and (2) Chinese CLE research mainly analyzed the pedagogical aspect of CLE, while English CLE research focused on CLE’s social and psychological aspects. We also discussed that future research should focus on (1) the balance of analyzing CLE from the perspective of students and other educational stakeholders such as teachers and school leaders, (2) student differences from the pedagogical level, (3) the physical level of CLE, (4) the use of statistical methods such as structural equation modeling that can analyze the mechanisms underlying the effects of CLE on student learning, and (5) the interdisciplinary research on CLE.

BackgroundA steep rise in the use of transcatheter aortic valve implantation (TAVI) for the management of symptomatic severe aortic stenosis occurred. Minimalist TAVI procedures and streamlined patient pathways within experienced Heart Valve Centres are designed to overcome the challenges of ever-increasing procedural volume.AimsThe 2022 European TAVI Pathway Survey aims to describe contemporary TAVI practice across Europe.Materials and methodsBetween October and December 2022, TAVI operators from 32 European countries were invited to complete an online questionnaire regarding their current practice.ResultsResponses were available from 147 TAVI centres in 26 countries. In 2021, the participating centres performed a total number of 27,223 TAVI procedures, with a mean of 185 TAVI cases per centre (median 138; IQR 77–194). Treatment strategies are usually (87%) discussed at a dedicated Heart Team meeting. Transfemoral TAVI is performed with local anaesthesia only (33%), with associated conscious sedation (60%), or under general anaesthesia (7%). Primary vascular access is percutaneous transfemoral (99%) with secondary radial access (52%). After uncomplicated TAVI, patients are transferred to a high-, medium-, or low-care unit in 28%, 52%, and 20% of cases, respectively. Time to discharge is day 1 (12%), day 2 (31%), day 3 (29%), or day 4 or more (28%).ConclusionReported adoption of minimalist TAVI techniques is common among European TAVI centres, but rates of next-day discharge remain low. This survey highlights the significant progress made in refining TAVI treatment and pathways in recent years and identifies possible areas for further improvement.

Background ACURATE neo2 is a transcatheter aortic valve implantation system consisting of a self‐expanding bioprosthetic valve with supra‐annular leaflet position and featuring innovations to facilitate placement accuracy and reduce paravalvular regurgitation. Methods and Results The goal of the Early neo2 (Early neo2 Registry of the ACURATE neo2 TAVI Prosthesis) was to gather real‐life data on safety and efficacy in a European transcatheter aortic valve implantation population treated with ACURATE neo2. Data were collected from 554 consecutive patients treated with ACURATE neo2 at 12 European sites (mean age, 82 years; 66% women; mean European System for Cardiac Operative Risk Evaluation II, 4.5%±3.8%) between September 2020 and March 2021. The composite primary end point was the occurrence of any of the following: postoperative (in‐hospital) paravalvular regurgitation grade ≥2, in‐hospital acute kidney injury stage 3, postoperative pacemaker implantation, 30‐day death, and 30‐day stroke. The primary end point occurred in 12.6% of patients. The 30‐day rates for all‐cause death and all stroke were 1.3% and 2.7%, respectively, and 1.5% of patients exhibited stage 3 acute kidney injury. A total of 34 patients (6.2%) received a postoperative permanent pacemaker. Per core laboratory–adjudicated echocardiographic analysis, mean postoperative aortic valve gradient was 7.6±3.3 mm Hg, and 2.8% of patients exhibited paravalvular regurgitation grade ≥2. Conclusions In this report of postmarket use of the ACURATE neo2 valve in a real‐world transcatheter aortic valve implantation population, patients exhibited favorable postoperative hemodynamics and clinical outcomes and a low rate of postoperative pacemaker implantation.

Background: Data on non-vitamin K antagonist oral anticoagulant (NOAC) use in patients with atrial fibrillation (AF) and a history of falls are limited. Therefore, we investigated the impact of a history of falls on AF-related outcomes, and the benefit-risk profiles of NOACs in patients with a history of falls. Methods: Using Belgian nationwide data, AF patients initiating anticoagulation between 2013 and 2019 were included. Previous falls that occurred ≤ 1 year before anticoagulant initiation were identified. Results: Among 254,478 AF patients, 18,947 (7.4%) subjects had a history of falls, which was associated with higher risks of all-cause mortality (adjusted hazard ratio (aHR) 1.11, 95%CI (1.06–1.15)), major bleeding (aHR 1.07, 95%CI (1.01–1.14)), intracranial bleeding (aHR 1.30, 95%CI (1.16–1.47)) and new falls (aHR 1.63, 95%CI (1.55–1.71)), but not with thromboembolism. Among subjects with a history of falls, NOACs were associated with lower risks of stroke or systemic embolism (aHR 0.70, 95%CI (0.57–0.87)), ischemic stroke (aHR 0.59, 95%CI (0.45–0.77)) and all-cause mortality (aHR 0.83, 95%CI (0.75–0.92)) compared to vitamin K antagonists (VKAs), while major, intracranial, and gastrointestinal bleeding risks were not significantly different. Major bleeding risks were significantly lower with apixaban (aHR 0.77, 95%CI (0.63–0.94)), but similar with other NOACs compared to VKAs. Apixaban was associated with lower major bleeding risks compared to dabigatran (aHR 0.78, 95%CI (0.62–0.98)), rivaroxaban (aHR 0.78, 95%CI (0.68–0.91)) and edoxaban (aHR 0.74, 95%CI (0.59–0.92)), but mortality risks were higher compared to dabigatran and edoxaban. Conclusions: A history of falls was an independent predictor of bleeding and death. NOACs had better benefit-risk profiles than VKAs in patients with a history of falls, especially apixaban.

This research utilises statistical modelling to explore the impact of roadway infrastructure elements, primarily those related to cross-section design, on crash occurrences in urban areas. Cross-section design is an important step in the roadway geometric design process as it influences key operational characteristics like capacity, cost, safety, and overall functionality of the transport system entity. Evaluating the influence of cross-section design on these factors is relatively straightforward, except for its impact on safety, especially in urban areas. The safety aspect has resulted in inconsistent findings in the existing literature, indicating a need for further investigation. Negative binomial (NB) models are typically employed for such investigations, given their ability to account for over-dispersion in crash data. However, the low sample mean and under-dispersion occasionally exhibited by crash data can restrict their applicability. The generalised Poisson (GP) models have been proposed as a potential alternative to NB models. This research applies GP models for developing crash prediction models for urban road segments. Simultaneously, NB models are also developed to enable a comparative assessment between the two modelling frameworks. A six-year dataset encompassing crash counts, traffic volume, and cross-section design data reveals a significant association between crash frequency and infrastructure design variables. Specifically, lane width, number of lanes, road separation, on-street parking, and posted speed limit are significant predictors of crash frequencies. Comparative analysis with NB models shows that GP models outperform in cases of low sample mean crash types and yield similar results for others. Overall, this study provides valuable insights into the relationship between road infrastructure design and crash frequency in urban environments and offers a statistical approach for predicting crash frequency that maintains a balance between interpretability and predictive power, making it more viable for practitioners and road authorities to apply in real-world road safety scenarios.

(1) Background: Left ventricular global longitudinal (LVGLS) and right ventricular free wall strain (RVFWS) demonstrated separate prognostic values in patients with severe aortic stenosis (AS). However, studies evaluating the combined assessment of LVGLS and RVFWS have shown contradictory results. This study explored the prognostic value of combining LVGLS and RVFWS in a large group of severe AS patients referred for transcatheter aortic valve implantation. (2) Methods: Patients were classified into three groups: preserved (LVGLS ≥ 15% AND RVFWS > 20%), single-ventricle impaired (LVGLS < 15% OR RVFWS ≤ 20%), or biventricular-impaired strain group (LVGLS < 15% AND RVFWS ≤ 20%). The cut-off values were based on previously published data and spline analyses. The endpoint was all-cause mortality. (3) Results: Of the 712 patients included (age 80 ± 7 years, 53% men), 248 (35%) died. The single-ventricle impaired and biventricular-impaired (vs. preserved) strain groups showed significantly lower 5-year survival rates (68% and 55% vs. 77%, respectively, p < 0.001). Through multivariable analysis, single-ventricle impaired (HR 1.762; 95% CI: 1.114–2.788; p = 0.015) and biventricular-impaired strain groups (HR 1.920; 95% CI: 1.134–3.250; p = 0.015) were independently associated with all-cause mortality. These findings were confirmed with a sensitivity analysis in patients with preserved LV ejection fraction. (4) Conclusions: In patients with severe AS, biventricular strain allows better risk stratification, even if LV ejection fraction is preserved.

Teaching point: Ingestion of a foreign body is a rare cause of a colovesical fistula.

Kinetic Monte Carlo (KMC) simulations are developed to simulate microstructure evolution under irradiation of structural materials of nuclear power plants. Methods based on rigid lattice atomic KMC and object KMC, despite some approximations, present the advantage to reach significant time, hence irradiation doses. The physical inputs such as the primary damage and defect cluster properties are the results of intensive atomic simulation on high performance computers. Here, atomic KMC is applied to model microstructure evolution of reactor pressure vessel steels and object KMC is applied to zirconium cladding materials.

In patients coming from countries with a high prevalence of tuberculosis and presenting with chronic infectious disease, tuberculosis with pulmonary and/or extrapulmonary involvement should be included in the differential diagnosis.

After publication of the original article [1], we were notified that an author's name has been incorrectly spelled. Author's first name is Hafid and the family name is Ait-Oufella (with a hyphen between Ait and Oufella). The original article has been corrected.

Abstract Hemodynamic monitoring is the centerpiece of patient monitoring in acute care settings. Its effectiveness in terms of improved patient outcomes is difficult to quantify. This review focused on effectiveness of monitoring-linked resuscitation strategies from: (1) process-specific monitoring that allows for non-specific prevention of new onset cardiovascular insufficiency (CVI) in perioperative care. Such goal-directed therapy is associated with decreased perioperative complications and length of stay in high-risk surgery patients. (2) Patient-specific personalized resuscitation approaches for CVI. These approaches including dynamic measures to define volume responsiveness and vasomotor tone, limiting less fluid administration and vasopressor duration, reduced length of care. (3) Hemodynamic monitoring to predict future CVI using machine learning approaches. These approaches presently focus on predicting hypotension. Future clinical trials assessing hemodynamic monitoring need to focus on process-specific monitoring based on modifying therapeutic interventions known to improve patient-centered outcomes.

DNA metabarcoding can be used in marine environmental monitoring if results are reproducible between labs and robust against modifications to the lab protocol. In this interlaboratory study, we conducted a ring test where subsamples of blended macrobenthos samples were distributed to four laboratories located in Belgium, the Netherlands, Germany and Denmark. Samples were processed by a standardized lab protocol and by an adapted protocol, and the resulting datasets were analyzed with the same bioinformatics pipeline. Different biodiversity indicators were calculated. Our results show that bulkDNA metabarcoding of marine macrobenthos offers a highly reproducible assessment of alpha diversity patterns when using a standardized protocol, since comparable species numbers, Shannon indices and Inverse Simpson indices were found between laboratories. Especially high abundant species and species with large body sizes were shared between the laboratories. The need for using a standardized protocol to enhance comparability in alpha diversity between different studies was shown. Beta diversity patterns are less subjected to changes in the metabarcoding protocol and were almost identical between different laboratories, as the main clustering was always based on the macrobenthic community, independent of the used protocol or the laboratory that conducted the work. We conclude that DNA metabarcoding for marine environmental monitoring is an appropriate method when the aim is to study changes in community patterns and advocate its implementation in routine monitoring programs of national and European authorities, providing that a standardized protocol is implemented and/or a detailed description of the protocol is available.

Encouraged by randomized controlled trials demonstrating non-inferiority of transfemoral transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) across all surgical risk categories, there has been a dramatic increase in the use of TAVI in a younger patient cohort with severe aortic stenosis, endorsed by both European and American Cardiac Societies. However, the standard use of TAVI in younger, less co-morbid patients with a longer life expectancy can only be supported if there is sound data demonstrating long-term durability of transcatheter aortic valves (TAVs). In this article, we have reviewed available randomized and observational registry clinical data pertaining to TAV long-term durability, placing emphasis on trials and registries using the new standardized definitions of bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF). Despite inherent difficulties in interpreting the available data, the determination reached is that the risk of structural valve deterioration (SVD) is potentially lower after TAVI than SAVR at 5 to 10 years, and that the two treatment modalities have a similar risk of BVF. This supports the adoption of TAVI in younger patients evident in current practice. However, the routine use of TAVI in younger patients with bicuspid aortic valve stenosis should be cautioned due to insufficient long-term TAV durability data in this particular patient population. Finally, we highlight the importance of future research into the unique potential mechanisms that can potentially contribute to TAV degeneration.

Therapeutic options for patients with isolated severe to torrential tricuspid regurgitation have been limited. Because a surgical option is often not attractive, new catheter-based therapies are emerging. We report the first-in-human percutaneous transcatheter tricuspid valve replacement with the MonarQ system in a 75-year-old female patient with severely symptomatic torrential tricuspid regurgitation. (Level of Difficulty: Advanced.)

This specific study investigates the chemical and morphological properties of naturally treated wheat straw fiber growing around in Jimma zone. The chemical composition properties including cellulose 45.43%, hemicellulose 36.50%, and lignin 21.61% were determined. The physical properties of naturally treated wheat straw fibers, such as bulk density, particle density, moisture content, and ash content, are 0.037 g/cm3, 0.194 g/cm3, 10.04%, and 1.44%, respectively. The chemical functional group of naturally treated wheat straw fiber was established by Fourier transform infrared spectroscopy (FTIR), crystallinity index is calculated by X-ray powder diffraction (×RD) analysis, and the thermogravimetric analysis (TGA) result ensures that the naturally treated wheat straw has thermally withstood up to 314.35°C. A fiber’s surface morphology shows the presence of shallow pores, which increase the surface roughness of the fiber; this contributes to increased contact surface area, which ensures better fiber-matrix adherence in composite fabrication. We conclude that naturally treated wheat straw fiber has a significant value in fiber reinforced concrete technology as reinforcement materials in concrete composites formation by incorporating optimum percentage to reduce the limitation of concrete and to enhance the mechanical properties of concrete.

While andragogy varies in meaning and practice from one country and context to another, it usually refers to the field of educating or guiding adults. This article reflects on a novel viewpoint and role for andragogy, taking as its starting point the broader European tradition that includes social welfare and community development. Central to its analysis is a new conception of community as moments of community that has been discreetly advanced in anthropological and continental--philosophical sources. It is argued that by contemplating and building on the great relevance of such moments andragogy can be made to play an innovative role in enabling moments of community in organizations, educational systems, neighborhoods, and society in general.

RESUMO Introdução: A reversão precoce da hipoperfusão tecidual induzida é essencial para a sobrevida no choque séptico. No entanto, falta consenso sobre a melhor estratégia de ressuscitação inicial, uma vez que intervenções destinadas a toda a população com choque séptico podem produzir administração desnecessária de líquidos. Este artigo relata a justificativa, o delineamento e o plano de análise do estudo ANDROMEDA-2, que visa determinar se uma estratégia guiada por perfusão periférica, que consiste na ressuscitação guiada pelo tempo de enchimento capilar com base em fenótipos clínicos e hemodinâmicos, está associada a uma diminuição no desfecho composto de mortalidade, tempo até a interrupção ao suporte de órgãos e tempo de internação em comparação com o atendimento padrão em pacientes com choque séptico precoce (< 4 horas do diagnóstico). Metódos: O estudo ANDROMEDA-2 é um ensaio clínico randomizado controlado multinacional e multicêntrico. No grupo de intervenção, o tempo de enchimento capilar será medido a cada hora, durante 6 horas. Se estiver anormal, os pacientes serão alocados em um algoritmo, começando com a avaliação da pressão de pulso. Pacientes com pressão de pulso inferior a 40mmHg serão testados quanto à capacidade de resposta a líquidos e receberão líquidos de acordo. Em pacientes com pressão de pulso > 40mmHg, norepinefrina será titulada para manter a pressão arterial diastólica > 50mmHg. Os pacientes que não normalizarem o tempo de enchimento capilar após as etapas anteriores serão submetidos à ecocardiografia de cuidados intensivos para avaliação da disfunção cardíaca e posterior manejo. Por fim, serão realizados testes com vasopressores e inodilatadores para otimizar ainda mais a perfusão. Um tamanho de amostra de 1.500 pacientes fornecerá 88% de poder para demonstrar a superioridade da estratégia direcionada ao tempo de enchimento capilar. Conclusão: Se for demonstrado que o direcionamento ao tempo de enchimento capilar é uma estratégia melhor, os processos de atendimento na ressuscitação do choque séptico podem ser otimizados com ferramentas usadas à beira do leito.

Abstract Background Approximately one in five women will experience mental health difficulties in the perinatal period. However, for a large group of women, symptoms of adverse perinatal mental health remain undetected and untreated. This is even more so for women of ethnic minority background, who face a variety of barriers which prevents them from accessing appropriate perinatal mental health care. Aims To explore minority ethnic women’s experiences of access to and engagement with perinatal mental health care. Methods Semi-structured interviews were conducted with 18 women who had been diagnosed with perinatal mental health difficulties and who were supported in the community by a specialist perinatal mental health service in South London, United Kingdom. Women who self-identified as being from a minority ethnic group were purposefully selected. Data were transcribed verbatim, uploaded into NVivo for management and analysis, which was conducted using reflective thematic analysis. Results Three distinct overarching themes were identified, each with two or three subthemes: ‘Expectations and Experiences of Womanhood as an Ethnic Minority’ (Shame and Guilt in Motherhood; Women as Caregivers; Perceived to Be Strong and Often Dismissed), ‘Family and Community Influences’ (Blind Faith in the Medical Profession; Family and Community Beliefs about Mental Health and Care; Intergenerational Trauma and Family Dynamics) and ‘Cultural Understanding, Empowerment, and Validation’ (The Importance of Understanding Cultural Differences; The Power of Validation, Reassurance, and Support). Conclusion Women of ethnic minority background identified barriers to accessing and engaging with perinatal mental health support on an individual, familial, community and societal level. Perinatal mental health services should be aware ethnic minority women might present with mental health difficulties in different ways and embrace principles of cultural humility and co-production to fully meet these women’s perinatal mental health needs.

Abstract Background Functional Respiratory Imaging (FRI) combines HRCT scans with computational fluid dynamics to provide objective and quantitative information about lung structure and function. FRI has proven its value in pulmonary diseases such as COPD and asthma, but limited studies have focused on cystic fibrosis (CF). This study aims to investigate the relation of multiple FRI parameters to validated imaging parameters and classical respiratory outcomes in a CF population. Methods CF patients aged > 5 years scheduled for a chest CT were recruited in a cross-sectional study. FRI outcomes included regional airway volume, airway wall volume, airway resistance, lobar volume, air trapping and pulmonary blood distribution. Besides FRI, CT scans were independently evaluated by 2 readers using the CF-CT score. Spirometry and the 6-Minute Walk Test (6MWT) were also performed. Statistical tests included linear mixed-effects models, repeated measures correlations, Pearson and Spearman correlations. Results 39 CT scans of 24 (17M/7F) subjects were analyzed. Patients were 24 ± 9 years old and had a ppFEV1 of 71 ± 25% at the time of the first CT. All FRI parameters showed significant low-to-moderate correlations with the total CF-CT score, except for lobar volume. When considering the relation between FRI parameters and similar CF-CT subscores, significant correlations were found between parameters related to airway volume, air trapping and airway wall thickening. Air trapping, lobar volume after normal expiration and pulmonary blood distribution showed significant associations with all spirometric parameters and oxygen saturation at the end of 6MWT. In addition, air trapping was the only parameter related to the distance covered during 6MWT. A subgroup analysis showed considerably higher correlations in patients with mild lung disease (ppFEV1 ≥ 70%) compared to patients with moderate to severe lung disease (ppFEV1

Abstract Background For patients with chronic obstructive pulmonary disease (COPD), greater improvements in lung function have been demonstrated for triple versus dual inhaled therapies in traditional spirometry studies. This study was the first to use functional respiratory imaging (FRI), known for increased sensitivity to airway changes versus spirometry, to assess the effect of the inhaled corticosteroid (ICS) component (budesonide) on lung function in patients with moderate-to-severe COPD and a blood eosinophil count > 150 cells/mm3. Methods Patients in this Phase IIIb (NCT03836677), randomized, double-blind, crossover study received twice-daily budesonide/glycopyrrolate/formoterol fumarate (BGF) 320/18/9.6 μg fixed-dose triple therapy and glycopyrrolate/formoterol fumarate (GFF) 18/9.6 μg fixed-dose dual therapy over 4 weeks, each delivered via a single metered dose Aerosphere inhaler. Primary endpoints were the improvements from baseline for each treatment in specific (i.e. corrected for lobar volume) image-based airway volume (siVaw) and resistance (siRaw) measured via FRI taken at total lung capacity (Day 29). Secondary outcomes included spirometry and body plethysmography. Adverse events were monitored throughout the study. Results A total of 23 patients were randomized and included in the intent-to-treat analysis (mean age 64.9 years, 78.3% males, 43.5% current smokers, mean predicted post-bronchodilator forced expiratory volume in 1 s [FEV1] 63.6%). BGF and GFF both statistically significantly increased siVaw from baseline at Day 29 (geometric mean ratio [GM], 95% confidence interval [CI]: 1.72 [1.38, 2.13] and 1.53 [1.28, 1.83], respectively, both p

ABSTRACT Introduction: Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5–7], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). Surgical Technique: We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane – virtually until the seminal vesicles – prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. Conclusions: Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention.

Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up. The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR. Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population. From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4%] vs 18,966/25,440 [74.6%]; heart failure: 1,407/2,544 [55.3%] vs 4,641/25,440 [18.2%]; chronic kidney disease: 633/2,544 [24.9%] vs 3,353/25,440 [13.2%]). In the last year of life, 650 of 2,544 patients (25.6%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6%) vs 38,833 of 49,438 (78.5%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0%) vs 4,924 of 49,438 (10.0%) were cardiovascular, and 790 of 6,943 (11.4%) vs 5,681 of 49,438 (11.5%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2%) vs 1,322 of 4,924 (26.8%) were because of heart failure in the TAVR group vs the controls. End of life for TAVR patients is characterized by high frailty and comorbidity burden. Importantly, most hospitalizations are of noncardiovascular cause, underscoring the need for a multidisciplinary approach toward end of life for TAVR patients. Future research is needed to improve follow-up and care in this patient population. [Display omitted] [ABSTRACT FROM AUTHOR]

Despite the challenges associated with periprocedural imaging, transcatheter tricuspid valve interventions have shown important impact on outcomes. A comprehensive understanding of the anatomy of the right heart and surrounding structures is crucial. One way to optimize these interventions is by identifying the optimal fluoroscopic viewing angles along the S-curve of the tricuspid valve. Integration of chamber views using multimodality imaging (multislice computed tomography, fluoroscopy, and echocardiography) may increase operator confidence and reduce procedural duration, radiation exposure, contrast volume, and complication rates. [Display omitted] [ABSTRACT FROM AUTHOR]

Hospitalizations are a major burden for both patients and society but are potentially preventable. We examined the one-year hospitalization burden in patients undergoing transcatheter aortic valve replacement (TAVR) and compared hospitalization rates and patterns with those undergoing isolated surgical aortic valve replacement (SAVR). Using Danish nationwide registries, we identified patients who underwent first-time TAVR and isolated SAVR (2008-2019), respectively. Subsequent hospitalizations were classified as cardiovascular or noncardiovascular according to discharge diagnosis codes. Patients undergoing TAVR (N = 4,921) were older and had more comorbidities than those undergoing SAVR (N = 5,220). There were 5,725 and 4,426 hospitalizations within the first year after discharge in the TAVR and SAVR group, respectively. During the one-year follow-up period post-TAVR, 46.6% were not admitted, 25.4% were admitted once, 12.6% twice, and 15.4% 3 times or more. The corresponding proportions in patients undergoing SAVR were 55.3%, 25.1%, 10.0%, and 9.5%, respectively. Among patients with ≥1 hospitalization following TAVR, 50.3% had a total length of all hospital stays between 1 and 7days, 19.0% 8-14days, 18.0% 15-30days, 9.9% 31-60days, and 2.8% ≥61days. The corresponding proportions for patients undergoing SAVR were 58.6%, 17.2%, 13.1%, 7.4%, and 3.7%, respectively. Compared with patients undergoing SAVR, those undergoing TAVR had a lower early (day0-30: HR 0.89 [95% CI, 0.80-0.98]), but a higher late hospitalization rate (day 31-365: 1.46 [1.32-1.60]). The 1-year hospitalization burden following TAVR is substantial. Compared with patients undergoing isolated SAVR, those undergoing TAVR had a lower early, but a higher late hospitalization rate – a difference that likely reflects unmeasured differences in the patient cohorts. [ABSTRACT FROM AUTHOR]

Over the past 50 years, there has been a major shift in age distribution of patients with congenital heart disease (CHD) thanks to significant advancements in medical and surgical treatment. Patients with CHD are, however, never cured and face unique challenges throughout their lives. In this review, we discuss the growing data suggesting accelerated aging in this population. Adults with CHD are more often and at a younger age confronted with age-related cardiovascular complications such as heart failure, arrhythmia, and coronary artery disease. These can be related to the original birth defect, complications of correction, or any residual defects. In addition, and less deductively, more systemic age-related complications are seen earlier, such as renal dysfunction, lung disease, dementia, stroke, and cancer. The occurrence of these complications at a younger age makes it imperative to further map out the aging process in patients across the spectrum of CHD. We review potential feasible markers to determine biological age and provide an overview of the current data. We provide evidence for an unmet need to further examine the aging paradigm as this stresses the higher need for care and follow-up in this unique, newly aging population. We end by exploring potential approaches to improve lifespan care.

The carrying capacity for vertical loads of well-maintained masonry arch bridges is reasonably high. This might not be the case for horizontal loads, the effects of which have not been the subject of extensive research aside from seismic occurrences. Arch bridges crossing rivers are subjected to sudden horizontal loads, due to river torrents, carrying debris from higher grounds. The magnitude of these horizontal loads is similar to those of coastal waves and debris; however, their effect on these structures has yet to be explored in detail. The narrow and high Devil’s Bridge across the Arda River (BG) and the wide, low Candia Viaduct across the Sesia River (I) were chosen as examples. Both are strongly exposed to fast-washing flow in the river during spring. FE simulations show that the impact of the rapidly rising river water influences the general stability, while the effect of debris mainly causes local damage. The results exhibit that tall, slender masonry arch structures fail due to the brittle fracture of the material, followed by the shear failure of a pier body. In contrast, lower and wider viaducts fail due to exaggerated tensile cracking in the upstream parts of a pier and the associated increasing pressure at its downstream parts.

(1) Background: Surgical phases form the basic building blocks for surgical skill assessment, feedback, and teaching. The phase duration itself and its correlation with clinical parameters at diagnosis have not yet been investigated. Novel commercial platforms provide phase indications but have not been assessed for accuracy yet. (2) Methods: We assessed 100 robot-assisted partial nephrectomy videos for phase durations based on previously defined proficiency metrics. We developed an annotation framework and subsequently compared our annotations to an existing commercial solution (Touch Surgery, Medtronic™). We subsequently explored clinical correlations between phase durations and parameters derived from diagnosis and treatment. (3) Results: An objective and uniform phase assessment requires precise definitions derived from an iterative revision process. A comparison to a commercial solution shows large differences in definitions across phases. BMI and the duration of renal tumor identification are positively correlated, as are tumor complexity and both tumor excision and renorrhaphy duration. (4) Conclusions: The surgical phase duration can be correlated with certain clinical outcomes. Further research should investigate whether the retrieved correlations are also clinically meaningful. This requires an increase in dataset sizes and facilitation through intelligent computer vision algorithms. Commercial platforms can facilitate this dataset expansion and help unlock the full potential, provided that the phase annotation details are disclosed.

This study aims to evaluate the abdominal aortic atherosclerotic plaque index (API)’s predictive role in patients with pre-operatively or post-operatively developed chronic kidney disease (CKD) treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). One hundred and eighty-three patients (134 with no pre- and post-operative CKD (no CKD) and 49 with persistent or post-operative CKD development (post-op CKD)) who underwent RAPN between January 2019 and January 2022 were deemed eligible for the analysis. The API was calculated using dedicated software by assessing the ratio between the CT scan atherosclerotic plaque volume and the abdominal aortic volume. The ROC regression model demonstrated the influence of API on CKD development, with an increasing effect according to its value (coefficient 0.13; 95% CI 0.04–0.23; p = 0.006). The Model 1 multivariable analysis of the predictors of post-op CKD found that the following are independently associated with post-op CKD: Charlson Comorbidity Index (OR 1.31; p = 0.01), last follow-up (FU) Δ%eGFR (OR 0.95; p < 0.01), and API ≥ 10 (OR 25.4; p = 0.01). Model 2 showed API ≥ 10 as the only factor associated with CKD development (OR 25.2; p = 0.04). The median follow-up was 22 months. Our results demonstrate API to be a strong predictor of post-operative CKD, allowing the surgeon to tailor the best treatment for each patient, especially in those who might be at higher risk of CKD.

Workplace learning in teacher education is essential for creating and recreating the professional identity of student teachers. Innovative interventions, such as team teaching between student teachers and mentors at the workplace, are assumed to facilitate learning to teach. This experimental study provides valuable insight into the impact of team teaching on student teachers’ professional identity by implementing distinct student teaching formats: team teaching (A1intervention), team teaching with support (A2intervention), and traditional teaching (Control intervention). In this study, professional identity is understood as a multidimensional concept that consists of six components: student teachers’ learning and regulation activities, reflective thinking, teacher efficacy, beliefs about learning and teaching, motivation, and collaborative activities. A total of 464 student teachers from a Flemish College of Education were randomly assigned to one of the three student teaching formats. The overall findings of Bayesian structural equation modeling reveal significant impacts of team teaching with support compared to both team teaching and traditional teaching as well as a significant impact of team teaching over traditional teaching on three crucial components of student teachers’ professional identity, i.e., their learning and regulation activities, reflective thinking, and motivation.

The present study aims at investigating whether events of socially shared metacognitive regulation (SSMR) differ from each other when comparing their characteristics. These differences are labelled "variations in SSMR". The study is conducted in a peer tutoring setting at university and includes video data (70 h of video recordings) on the regulation behaviour of thirty students who participated in a semester-long peer tutoring intervention that was directed at knowledge co-construction. In addition to studying variations in SSMR, the current study aims at examining whether individual students' engagement in variations in SSMR is related to their performance on a knowledge test taken immediately after the peer tutoring intervention. Latent class cluster models were run to explore the presence of variations in SSMR. The trigger for SSMR, the number of students actively involved in SSMR, the level of elaboration during SSMR, and the function of SSMR in the collaborative learning process were included in the model as input parameters. A four-cluster model was selected as the best fitting model that demonstrated statistical significance. The four identified variations of SSMR were labelled as 'interrogative SSMR', 'affirmative SSMR', 'interfering SSMR', and 'progressive SSMR'. Regression analyses revealed that not all variations in SSMR are equally important for predicting students' performance. Students' engagement in interrogative SSMR was significantly positively related to students' performance on the knowledge test, whereas their engagement in interfering SSMR was negatively related. In contrast, the frequency of students' involvement in affirmative SSMR or progressive SSMR demonstrated no significant relation with students' performance. By unravelling the multifaceted character of SSMR, the present study allows to extend and to refine the emerging theory on shared regulation.

The study's main aim was to explore the role of Facebook class groups, created and managed by high-school students, in facilitating social dynamics and learning experiences. Fourteen Facebook class groups were observed online and students were subsequently questioned through focus-group interviews. Our findings show that Facebook class groups can promote both bonding and learning. Bonding can be enhanced because Facebook class groups foster a sense of solidarity and unity among students. Also, Facebook can stimulate (social) learning because students gain more insights in the subject matter and are challenged to carry out an evaluation of their own study methods and progress. Therefore, drawing on the theories of seamless learning and affinity spaces, we conclude that Facebook class groups are important for social affiliation and effective learning.

This study aims to explore the existence and extent of social media visions, policies and guidelines in high schools in Flanders (Belgium, Europe) and how these policies are embedded in the schools. The research findings are based on qualitative data collected in 47 high schools. Next to an in-depth document analysis of all available school regulations, semi-structured interviews were carried out with school staff appointed to social media affairs. Results show a wide variety of guidelines amongst schools. In addition, schools often experience struggles in determining their position within the social media debate. Defining the school's role in when and how to intervene against the use of and problems with social media appears to be difficult. In conclusion, this study provides input for the design of more coherent school policy decisions facilitative to social media' use and consequently, contributing to the wellbeing of both students and teachers in high schools.

Parents play an important part in adolescents' life and significantly contribute to youngsters' academic success. However, parents' and students' perceptions regarding parental involvement may differ and how these perceptions are related to school achievement and wellbeing have been poorly researched. Therefore, self-report measures assessing students' and parents' perceptions of parental involvement were completed, using a sample of 5003 7th grade students and their parents. The results indicate parallels between parent and student perceptions. However, parents indicate a higher extent of parental involvement compared to students. According to students, parents focus on monitoring grades, whereas parents display the highest scores for interest in school and learning. Parental involvement seems to impact student achievement and wellbeing. Nevertheless, effects are small, and the effects of socio-demographic variables overrule these effects. These results give insight in different perceptions on parental involvement and underpin the importance of middle school students as active participants in learning.

Online celebrity bashing refers to a specific subform of online aggression in which celebrities are the targets of derogatory messages. Recent research focusing on the underlying explanations of why some bystanders turn into perpetrators of celebrity bashing suggests that human capacity for empathy may regulate the involvement in this practice. Bystanders with higher empathy are thought to show more disapproval towards online celebrity bashing, which makes them less likely to join in this practice. However, little is known about the processes of how empathy steers bystanders' bashing attitudes and behavior. In this study, we examine whether the oxytocinergic system, which forms the neurophysiological foundation of empathy, influences the bystanders' acceptance of online celebrity bashing. In a double-blind, placebo-controlled experiment, we tested the effects of intranasal oxytocin administration on acceptance of celebrity bashing in men. Sixty participants rated neutral or derogatory comments presented as "tweets." Electrodermal activity and electrocardiogram of the participants were recorded to control for the stress levels. The results showed that oxytocin administration reduced the acceptance of celebrity bashing. Celebrity bashing was unrelated to stress levels. In natural circumstances oxytocin levels are dependent on the presence and quality of one's social relationships. As a result, we discuss the importance of facilitating a network of social support in programs addressing the problem of online aggression.

BackgroundDue to their high media use, young adults are frequently exposed to contradictory or even erroneous nutrition information. To properly handle and critically assess nutrition information, young adults (both general population and patient populations) need adequate levels of nutrition literacy. Currently there is a lack of suitable instruments to measure nutrition literacy in young adults (18–25 years). Therefore the aim of this study was to develop and validate a Short Nutrition Literacy (S-NutLit) scale for use in this age group.MethodsDevelopment and validation of the S-NutLit consisted of six phases: (1) item generation based on literature, (2) expert assessments to evaluate content validity, (3) cognitive interviews with the target population to assess face validity and readability, (4) pre-test to reduce the number of items, (5) validation survey to assess dimensionality with exploratory factor analyses, internal reliability with Cronbach alpha, construct and criterion validity by examining associations with age, gender, education level, health literacy, general literacy, dietary behaviors and physical activity with correlations, ANOVAs, and t-tests, (6) two-week follow-up survey to assess test–retest reliability with intra-class correlations.ResultsStarting from an initial pool of 53 items, expert assessments and cognitive interviews led to the reformulation, removal, and construction of items. Young adults aged 18–25 years participated in cognitive interviews (n = 12), pre-test (n = 101), validation survey (n = 300), and reliability survey (n = 92). The final S-NutLit consisted of 11 items rated on a 5-point scale distributed across two subscales (i.e., information skills and expert skills). Cronbach alpha values ranged from 0.79 to 0.83 and intraclass correlations from 0.61–0.79 (p

Marfan syndrome is an autosomal dominant genetic disorder resulting from pathogenic variants in FBN1 gene. FBN1 encodes for fibrillin-1, an important extracellular matrix protein. Impaired fibrillin-1 affects multiple organ systems, including the cardiovascular system. We generated an iPSC line carrying a heterozygous variant c.7754 T > C (p.Ile2585Thr, missense) in FBN1 from a patient with Marfan syndrome. Also, an isogenic control is generated, where the pathogenic variant is repaired using CRISPR-Cas9. This isogenic pair provides a valuable resource for in vitro disease modelling.

BackgroundMicrovascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome.MethodsThe COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients.ResultsA total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients.ConclusionOCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis.Clinical trial registrationClinicalTrial.gov, identifier NCT04410549.