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Accurate, detailed, and standardized phenotypic descriptions are essential to support diagnostic interpretation of genetic variants and to discover new diseases. The Human Phenotype Ontology (HPO), extensively used in rare disease research, provides a rich collection of vocabulary with standardized phenotypic descriptions in a hierarchical structure. However, to date, the use of HPO has not yet been widely implemented in the field of inborn errors of immunity (IEIs), mainly due to a lack of comprehensive IEI-related terms. We sought to systematically review available terms in HPO for the depiction of IEIs, to expand HPO, yielding more comprehensive sets of terms, and to reannotate IEIs with HPO terms to provide accurate, standardized phenotypic descriptions. We initiated a collaboration involving expert clinicians, geneticists, researchers working on IEIs, and bioinformaticians. Multiple branches of the HPO tree were restructured and extended on the basis of expert review. Our ontology-guided machine learning coupled with a 2-tier expert review was applied to reannotate defined subgroups of IEIs. We revised and expanded 4 main branches of the HPO tree. Here, we reannotated 73 diseases from 4 International Union of Immunological Societies–defined IEI disease subgroups with HPO terms. We achieved a 4.7-fold increase in the number of phenotypic terms per disease. Given the new HPO annotations, we demonstrated improved ability to computationally match selected IEI cases to their known diagnosis, and improved phenotype-driven disease classification. Our targeted expansion and reannotation presents enhanced precision of disease annotation, will enable superior HPO-based IEI characterization, and hence benefit both IEI diagnostic and research activities. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Background: Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. Objective: Although the short-term effect on complications is increasingly being recognized, the impact on long-term survival remains unclear. This study aims to investigate the association between postoperative complications following MIE and long-term survival. Methods: Data were collected from the EsoBenchmark Collaborative composed by 13 high-volume, expert centers routinely performing MIE. Patients operated between June 1, 2011 and May 31, 2016 were included. Complications were graded using the Clavien-Dindo (CD) classification. To correct for short-term effects of postoperative complications on mortality, patients who died within 90 days postoperative were excluded. Primary endpoint was 5-year overall survival. Results: A total of 915 patients were included with a mean follow-up time of 30.8 months (standard deviation 17.9). Complications occurred in 542 patients (59.2%) of which 50.2% had a CD grade ≥III complication [ie, (re)intervention, organ dysfunction, or death]. The incidence of anastomotic leakage (AL) was 135 of 915 patients (14.8%) of which 84 patients were classified as a CD grade ≥III. Multivariable analysis showed a significantly deteriorated long-term survival in all patients with AL [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.25–2.24]. This inverse relation was most distinct when AL was scored as a CD grade ≥III (HR 1.83, 95% CI 1.30–2.58). For all other complications, no significant association with long-term survival was found. Conclusion: The occurrence and severity of AL, but not overall complications, after MIE negatively affect long-term survival of esophageal cancer patients. [ABSTRACT FROM AUTHOR]

Self-management is an essential component of the curative treatment trajectory of esophageal cancer patients. The aims of this study were to explore expectations and needs of esophageal cancer patients during curative treatment regarding self-management, relevant aspects of self-management in which they need additional support, and to explore their willingness to use eHealth. Semi-structured interviews were conducted with esophageal cancer patients, who had been treated with neoadjuvant chemo(radio)therapy followed by surgery, maximally 1 year after surgery. Based on the general model of self-management, the following themes were discussed: experience-based knowledge, contribution to care, living with the condition, and organization of care and support. A stepwise systematic text condensation guided the data analysis. All four domains of the general model of self-management were identified. All participants described a remarkable difference between the pre-operative pathway, when it felt like they were taken by the hand, and the postoperative pathway, when it felt like they were thrown into the deep end. They adjusted to their new life situation by learning new experiences, while dealing with their diminished confidence in their bodies. Patients expressed the need for support from different sources, and were open to the idea of using eHealth in addition to usual care. (digital) Self-management support should be easily accessible, person-centered, confidential, and include personal contact. Differences were found among esophageal cancer patients regarding self-management, self-management support and eHealth for self-management purposes, indicating there is no one approach that will meet the needs of all patients at all times. • Self-management is an essential component of curative treatment of esophageal cancer patients. • A digital self-management support tool could be of additional value to support them. • This study focuses on (digital) selfmanagement support needs of patients with esophageal cancer during curative treatment. • (Digital) Self-management support should be confidential, easily accessible, person-centered, and contain personal contact. [ABSTRACT FROM AUTHOR]

The pivotal clinical trials have largely demonstrated the efficacy and safety of ustekinumab in Crohn's disease. Real-life cohorts published so far only include very few bio-naïve patients. This study assesses effectiveness and safety of ustekinumab in bio-naïve and bio-failure patients treated with ustekinumab in routine practice and look for predictors of response. We performed a retrospective monocentric study. Initial response was assessed by maintenance therapy beyond week 16. Sustained response was assessed by the continuation or cessation of therapy over time for another reason than stopping in sustained remission. Treatment persistence was assessed by Kaplan Meier curves and predictors of treatment persistence were studied by univariate and multivariate Cox model. Out of 156 recorded patients, three patients were still in their induction phase at time of analysis and 5 patients were lost to follow-up, leaving 148 patients for clinical effectiveness analyses, including 35 bio-naïve when starting ustekinumab. A maintenance therapy was initiated in 79.7%. At one year, the probability to be still treated with ustekinumab was 73.8%. Treatment cessation increased with smoking in multivariate analysis. Previous biologic failure (as a whole), CRP and fecal calprotectin baseline levels did not influence initial response and treatment persistence. A large proportion of CD patients initially respond to ustekinumab and continue this treatment beyond one year. Treatment persistence is as high in bio-failure as in bio-naïve patients. [ABSTRACT FROM AUTHOR]

This work presents an integrated geochronology study combining step-heating Ar-Ar and in-situ Rb-Sr phyllosilicate geochronology with EPMA elemental maps and U-Pb apatite geochronology in order to determine the timing and duration of regional deformation and fluid circulation processes in the Karagwe-Ankole Belt in Central Africa. The Kibuye-Gitarama-Gatumba study area (West Rwanda) forms part of the Western Domain of this Mesoproterozoic belt, where the metamorphic and deformation history, geothermometric evolution and mineralization processes (both genesis and geochronology) have been well-documented in previous studies. Our geochronological results and interpretations show the importance of thermal diffusion throughout the elevated temperature regime present in the Neoproterozoic. During the Ediacaran, metamorphism and fluid alteration in the Gatumba area was associated with deformation, as independently demonstrated by U-Pb apatite and Ar-Ar phyllosilicate geochronology. From the end of the Ediacaran until the Late Cambrian, saline fluid activity is recorded and fluid-induced (re)crystallization processes dominate the Gatumba biotite isotope record. The direct comparison between and Ar-Ar geochronology suggests a parentless 40Ar-component is preserved during this fluid-induced (re)crystallization due to its saline, (earth) alkali-rich composition. Additionally, this multi-method approach allows us to place the history of the Western Domain of the Karagwe-Ankole belt in relation to that of the surrounding areas, i.e. the Eastern Domain and the Congo and Tanzania Cratons. Deformation and epidote-amphibolite facies metamorphism (at ~590–570 Ma), and fluid fluxes (at ~590–495 Ma) occurred in the Kibuye-Gitarama-Gatumba area after the West Gondwana Orogeny but from the onset of the East African Orogeny onwards till after the culmination of the Gondwana amalgamation, demonstrating the progressively eastward-moving orogenic front in this supercontinent assembly. Unlabelled Image • Integrated geochronology resolves the interplay of fluid, deformation, metamorphism. • Combined Ar-Ar and Rb-Sr mica geochronology suggests parentless 40Ar component. • Uplift followed by fluid fluxes show eastward-moving East African orogenic front. [ABSTRACT FROM AUTHOR]

There are several parallel networks of education in Belgium and competition and rivalry between them is a constant phenomenon. The different school sectors, financing of education, innovating role of cities and muncipalities, and the education of migrant children are discussed. (MLW)

Discusses origins and organization of technical engineering schools in Belgium, the development of higher technical education, industrial colleges, legislation affecting technical education, and considerations on the future of industrial colleges. Journal availability: see SO 507 243. (Author/DB)

The development of postsecondary technical engineering education in Belgium is traced. Problems that are discussed include: the proliferation of engineering schools, government role, industry school relationship, and the maintenance of high quality engineering programs. (BH)

The development of headmaster (principal) training in Belgium and the role of the University of Antwerp in program development is reported. The need for secondary school administrator training is discussed, as well as the strategy that evolved to meet this need. Despite favorable evaluation, questions remain regarding headmaster alienation. (Author/FG)

Physical activity (PA), sedentary behavior (SB) and sleep (i.e. 24-h movement behaviors) are associated with health indicators in people with prediabetes and type 2 diabetes (T2D). To optimize 24-h movement behaviors, it is crucial to identify explanatory variables related to these behaviors. This review aimed to summarize the explanatory variables of 24-h movement behaviors in people with prediabetes or T2D. A systematic search of four databases (PubMed, Web of Science, Scopus & Embase) was performed. Only objective measurements of 24-h movement behaviors were included in the search strategy. The explanatory variables were classified according to the levels of the socio-ecological model (i.e. intrapersonal, interpersonal and environmental). The risk of bias was assessed using the Joanna Briggs Institute appraisal checklist. None of the 78 included studies investigated 24-h movement behaviors. The majority of the studies investigated PA in isolation. Most studied explanatory variables were situated at the intrapersonal level. Being male was associated with more moderate to vigorous PA but less light PA in people with T2D, and more total PA in people with prediabetes. An older age was associated with a decrease in all levels of PA in people with T2D. HbA1c was positively associated with sleep and SB in both groups. No associations were found at the interpersonal or environmental level. The results of this review underscore the lack of a socio-ecological approach toward explanatory variables of 24-h movement behaviors and the lack of focus on an integrated 24-h movement behavior approach in both populations. • The most frequently studied explanatory variables of all movement behaviors are situated at the intrapersonal level. • Limited research is available on explanatory variables of movement behaviors among people with prediabetes. • Research on the variables of integrated 24-h movement behaviors among people with prediabetes and type 2 diabetes is lacking. • Insight into the variables of 24-h movement behaviors may provide guidance for tailored interventions in these populations. [ABSTRACT FROM AUTHOR]

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) was recently introduced to treat unresectable peritoneal metastases. Adding an electrostatic field may enhance charged droplet precipitation and tissue penetration, resulting in improved anticancer efficacy. We report for the first time its safety and preliminary efficacy. Patients underwent PIPAC combined with an electrostatic field, using the Ultravision™ apparatus. Adverse events were scored with the Common Terminology Criteria. Treatment response was assessed after more than one PIPAC, using clinical symptoms, tumor markers, CT imaging and histological regression. Forty-eight patients (median age, 61 y) with diverse primary tumors underwent 135 procedures (median per patient, 3). Most (65.2%) were treated as outpatient. Twenty-eight (58.3%) patients received concomitant chemotherapy. The most frequent treatment-related toxicities were anemia (grade 1 to 3, 13 [9.6%]), ileus (grade 1 to 3, 5 [3.7%]), anorexia (grade 1 to 3, 6 [4.4%]), nausea (grade 1 to 3, 5 [3.7%]) and vomiting (grade 1 to 3, 7 [5.2%]). There was no grade 4 or 5 morbidity. Twenty (41.7%) patients did not complete three treatments, mainly because of disease progression (n = 13). After two procedures, there were one responder and 8 non-responders. After three treatments, we observed 11 responders, two patients with stable disease, and 15 non-responders. All but one patient with therapy response received simultaneous chemotherapy. Electrostatic precipitation during PIPAC is well tolerated and safe. After three procedures and concomitant chemotherapy, response or stable disease is achieved in approximately half of cases. These findings warrant prospective trials in homogeneous patient cohorts. [ABSTRACT FROM AUTHOR]

The aim of this exploratory survey was to provide an overview of physiotherapeutic and occupational therapeutic techniques and outcome measures applied in practice within palliative care. An anonymous web-based questionnaire was distributed to physiotherapists and occupational therapists in Flanders, Belgium between December 2017 and February 2018. A total of 91 respondents were included. Frequently applied interventions were: massage (51%), mobilization (49%), exercise therapy (46%), manual lymphatic drainage (42%), walking rehabilitation (40%) and breathing therapy (32%). Additional therapeutic aspects such as 'comfort care' and 'creating a therapeutic alliance' were mentioned by 34% of all therapists and cannot be ignored as an important part of treatment. Outcome measures were not always used to evaluate treatment because of time constraints and because progress was considered difficult to conceptualize in a palliative care context. The most frequently used outcome measures were a visual analogue scale (VAS) and the 6-minute walk test. In this study, the most frequently applied physiotherapeutic and occupational therapeutic interventions within palliative care were massage, mobilization and exercise therapy. However, therapists stress that these techniques are not mandatory, since care is always informed by the individual comfort and daily functioning of patients. Other than a VAS, outcome measures were used minimally. [ABSTRACT FROM AUTHOR]