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Using puppets in language learning is unusual in secondary or higher education but has agreat potential to allow students to develop their language skills and creativity. Shy students can learn to engage in open discussions – a requirement for the oral exam – by speaking through the puppet. I wanted to investigate whether young adult learners are willing to engage in such rather unusual but promising method and record their experiences. This article gives an overview of the approach and summarises the student feedback received. I love to watch puppet shows. And I am a language teacher. Having used hand puppets and shadow puppets in a supplementary school, teaching German to 8 to 9-year-old children, I could immediately see their interest rising when I introduced the puppets. The children were mesmerised, focused and happy to engage in activities. But usually I am teaching German to young adults. I have been a German teacher at King’s College’s Modern Language Centre for 15 years now, and my students are undergrads and postgrads in language courses from A1 to C2 level of the CEFR. I was wondering whether puppets would spark the same interest and engagement in such young adults as it did ...

Gerrit J Bouma,1 Wimar van den Brink,2 Larry E Miller,3 Jasper FC Wolfs,4 Mark P Arts5 1Department of Neurosurgery, OLVG and Amsterdam University Medical Centers, Amsterdam, The Netherlands; 2Neurochirurgisch Centrum Zwolle, Zwolle, The Netherlands; 3Miller Scientific Consulting, Asheville, NC, USA; 4Haaglanden Medical Center Westeinde Antoniushove, Leidschendam, The Netherlands; 5Department of Neurosurgery, Haaglanden Medical Center Westeinde, The Hague, The NetherlandsCorrespondence: Gerrit J BoumaDepartment of Neurosurgery, OLVG and Amsterdam University Medical Centers, P.O. Box 22700, Amsterdam 1100 DD, The NetherlandsTel +31-20-5669111Email g.j.bouma@amc.uva.nlBackground: Awareness of treatment group assignment in a clinical trial may influence patient behavior and bias outcome reporting. The objective of this study was to compare 2-year clinical outcomes in blinded vs unblinded patients who were treated with lumbar discectomy and a bone-anchored annular closure device (ACD) for prevention of lumbar disc reherniation.Methods: This was a secondary analysis of a randomized trial comparing lumbar discectomy with (n=272) vs without (n=278) implantation of a bone-anchored ACD. Among patients who received ACD implantation, 35 (13%) were blinded and 237 (87%) were unblinded to treatment allocation. In patients treated with ACD, propensity score-matching (1:1) was performed to account for imbalances in patient characteristics between blinded and unblinded groups. Key clinical outcomes were back pain severity (0–100 scale), leg pain severity (0–100 scale), Oswestry Disability Index (ODI, 0–100 scale), symptomatic reherniation, reoperation at the treated lumbar level, and device- or procedure-related serious adverse events (AEs). Outcomes were reported through 2 years of follow-up, which coincided with the time at which blinded patients were unblinded.Results: There were no statistically significant differences in 2-year outcomes between propensity score-matched blinded (n=35) and unblinded (n=35) patients treated with the ACD. In blinded vs unblinded ACD patients compared to baseline, back pain severity decreased by 40 vs 37 points (P=0.61), leg pain severity decreased by 75 points in each group (P>0.99), and ODI decreased by 47 vs 43 points (P=0.19). The risks of symptomatic reherniation (5.7% vs 9.1%; P=0.59), reoperation (8.6% vs 12.2%, P=0.62), and device- or procedure-related serious AEs (5.7% vs 8.9%, P=0.63) were comparably low in blinded and unblinded patients.Conclusion: In patients treated with lumbar discectomy and a bone-anchored ACD, there were no clinically important or statistically significant differences in back pain, leg pain, ODI, symptomatic reherniation, reoperation, or serious AEs over 2 years of follow-up when comparing patients who were blinded vs unblinded to their treatment assignment. The main limitations of this study were the post hoc nature of the analysis and the potential for bias due to surgeon awareness of treatment assignment.Keywords: annulus fibrosus, blinding, disc, discectomy, elderly, herniation, lumbar, sciatica

Dharmin Nanda1, Mark P Arts2, Larry E Miller3, Hans-Peter Köhler4, Jason M Perrin5, Charlotte Flüh6, Peter Vajkoczy7 1Department of Neurosurgery, Isala Klinieken, Zwolle, the Netherlands; 2Department of Neurosurgery, Haaglanden Medical Center Westeinde, The Hague, the Netherlands; 3Miller Scientific Consulting, Inc., Asheville, NC, USA; 4Department of Neurosurgery, Asklepios Westklinikum Hamburg, Hamburg, Germany; 5Department of Neurosurgery, University Clinic Mannheim, Mannheim, Germany; 6Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany; 7Department of Neurosurgery, Charité Universitätsmedizin, Berlin, GermanyCorrespondence: Dharmin NandaDepartment of Neurosurgery, Isala Klinieken, Dokter van Heesweg 2, AB Zwolle 8025, The NetherlandsTel +31 038 424 5000Email nanda@neurochirurgie-zwolle.nlObjective: To determine whether implanting an annular closure device (ACD) following a lumbar discectomy procedure in patients with large defects in the annulus fibrosus lowers the risk of reoperation after 4 years.Methods: In a multicenter randomized trial, patients with large annular defects following single-level lumbar discectomy were intraoperatively randomized to additionally receive an ACD or no treatment (Controls). Clinical and imaging follow-up were performed at routine intervals over 4 years of follow-up. Main outcomes included reoperations at the treated lumbar level, leg pain scores on a visual analog scale, Oswestry Disability Index (ODI), and Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36 questionnaire.Results: Among 550 patients (ACD 272, Control 278), the risk of reoperation over 4 years was 14.4% with ACD and 21.1% with Controls (P=0.03). The reduction in reoperation risk with ACD was not significantly influenced by patient age (P=0.51), sex (P=0.34), body mass index (P=0.21), smoking status (P=0.85), level of herniation (P=0.26), leg pain severity at baseline (P=0.90), or ODI at baseline (P=0.54). All patient-reported outcomes improved in each group from baseline to 4 years (all P

BackgroundRandomized controlled trials (RCTs) often provide accurate estimates of the internal validity of an intervention but lack information on external validity (generalizability). We conducted an RCT on the effectiveness of a self-management intervention among patients with lymphoma in a population-based setting. ObjectiveThe objectives of the current study were to describe the proportion of RCT participants compared to all patients invited to participate, and compare sociodemographic and clinical characteristics of RCT participants with all respondents, all patients invited to participate, and all patients selected from the Netherlands Cancer Registry (NCR) to determine the reach of the intervention. An additional objective was to assess differences on RCT outcome variables between RCT and paper respondents. MethodsPatients with lymphoma or chronic lymphocytic leukemia ≥18 years old at diagnosis from 13 hospitals in the Netherlands were selected from the population-based NCR, which routinely collects data on sociodemographic and clinical characteristics. Eligible patients were invited to participate in an RCT and complete a questionnaire. Web-based completion determined RCT enrollment, whereas paper respondents were followed observationally. ResultsA total of 1193 patients were selected from the NCR, 892 (74.77%) of whom were invited to participate in the trial by their hematologist after verifying eligibility. Among those invited, 25.4% (227/892) completed the web-based questionnaire and were enrolled in the RCT. The RCT participants were younger and there was a higher proportion of men than nonparticipants (P

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Justine M Briët,1 Marian JE Mourits,1 Barbara L van Leeuwen,2 Edwin R van den Heuvel,3 Monique JA Kenkhuis,1 Henriette JG Arts,1 Geertruida H de Bock3 1Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 2Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 3Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands Purpose: A prospective, multicenter cohort study was performed on the implementation of laparoscopic hysterectomy (LH) in the Netherlands. The aim of this study was to evaluate the impact of LH on quality of life (QOL) with respect to age up to 6 months postoperatively. Patients and methods: Women with an indication for LH, either for benign conditions or early-stage low-risk endometrial cancer were included. QOL was measured before and 6 weeks and 6 months after surgery, using the 36-item Short Form Health Survey. Mean QOL values were compared to an unselected, female, Dutch reference population. A longitudinal linear mixed model was applied to assess changes in QOL over time after LH and to determine if in patients ≥65 years of age QOL scores were different. Results: Data on 116 patients were available for analysis. The median age was 54 years at time of surgery (range 34–83) with an interquartile range of 43–65 years. Six months after LH, all QOL values were higher than before surgery and were equal to or higher than those of the reference population. Older women tend to score higher on QOL preoperatively, and these scores remain high postoperatively. Conclusion: After LH, QOL improves. Older women report higher QOL values preoperatively and QOL is still high 6 months after the operation. Age does not confer a negative impact on QOL following LH and should not be the reason to refrain from laparoscopic surgery. Keywords: quality of life, laparoscopic surgery, hysterectomy, elderly

Nicolaas JM Arts,1,2 Serge JW Walvoort,1 Roy PC Kessels1,3,4 1Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, 2Neuropsychiatry Center Thalamus, Institution for Integrated Mental Health Care Pro Persona, Wolfheze, 3Department of Neuropsychology and Rehabilitation Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 4Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands Abstract: In this review, we present a survey on Korsakoff’s syndrome (KS), a residual syndrome in patients who suffered from a Wernicke encephalopathy (WE) that is predominantly characterized by global amnesia, and in more severe cases also by cognitive and behavioral dysfunction. We describe the history of KS and its definition, its epidemiology, and the lack of consensus criteria for its diagnosis. The cognitive and behavioral symptoms of KS, which include anterograde and retrograde amnesia, executive dysfunction, confabulation, apathy, as well as affective and social-cognitive impairments, are discussed. Moreover, recent insights into the underlying neurocognitive mechanisms of these symptoms are presented. In addition, the evidence so far on the etiology of KS is examined, highlighting the role of thiamine and alcohol and discussing the continuity hypothesis. Furthermore, the neuropathology of KS is reviewed, focusing on abnormalities in the diencephalon, including the mammillary bodies and thalamic nuclei. Pharmacological treatment options and nonpharmacological interventions, such as those based on cognitive rehabilitation, are discussed. Our review shows that thiamine deficiency (TD) is a crucial factor in the etiology of KS. Although alcohol abuse is by far the most important context in which TD occurs, there is no convincing evidence for an essential contribution of ethanol neurotoxicity (EN) to the development of WE or to the progression of WE to KS. Future research on the postmortem histopathological analysis of brain tissues of KS patients is crucial for the advancement of our knowledge of KS, especially for associating its symptoms with lesions in various thalamic nuclei. A necessary requirement for the advancement of studies on KS is the broad acceptance of a comprehensive definition and definite diagnostic criteria. Therefore, in this review, we propose such a definition of KS and draft outlines for prospective diagnostic criteria. Keywords: Korsakoff’s syndrome, alcohol amnestic disorder, Wernicke encephalopathy, thiamine deficiency, ethanol neurotoxicity, thalamus, memory, executive function, history

Peter Douglas Klassen,1 Derek Thomas Bernstein,2 Hans-Peter Köhler,3 Mark P Arts,4 Bradley Weiner,2 Larry E Miller,5 Claudius Thomé6 On behalf of the Annular Closure RCT Study Group 1Department of Neurosurgery, St. Bonifatius Hospital, Lingen, Germany; 2Department of Orthopaedic Surgery, Methodist Hospital, Houston, TX, USA; 3Department of Neurosurgery, Asklepios Westklinikum Hamburg, Hamburg, Germany; 4Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands; 5Miller Scientific Consulting, Inc., Asheville, NC, USA; 6Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria Purpose: The purpose of this study was to evaluate perioperative complications of lumbar discectomy with or without bone-anchored annular closure device (ACD) implant in patients at high risk of recurrent disc herniation. Methods: This was a post hoc analysis of a randomized controlled trial that compared outcomes of lumbar discectomy with or without additional placement of an ACD. Patients presented with imaging evidence of lumbar disc herniation and radicular pain that was unresponsive to conservative care. Randomization occurred intraoperatively following discectomy completion and confirmation of annular defect width ≥6 mm. Main outcomes included serious adverse events (SAEs) from any cause, device- or procedure-related SAEs, and reoperations at the index level. The perioperative period included all outcomes occurring between the day of surgery and 90 days following hospital discharge. Results: Analyses were performed on a modified intention-to-treat population consisting of 272 patients treated with ACD and 278 patients treated with lumbar discectomy only (controls). Mean patient age was 44 years, 59% were men, and mean body mass index was 26 kg/m2. Baseline patient characteristics and operative outcomes were comparable between groups. The risks of all-cause SAE (9.7% vs 16.3%, p=0.056), device- or procedure-related SAE (4.5% vs 10.2%, p=0.02), and index-level reoperation (1.9% vs 5.4%, p=0.03) were lower with ACD vs controls. In multivariable logistic regression, control group assignment and female gender were independently associated with higher risk of device- or procedure-related SAE and index-level reoperation, respectively. Conclusion: In patients undergoing lumbar discectomy to treat symptomatic intervertebral disc herniation, adjunctive placement of an ACD reduces the risk for perioperative complications occurring through 90 days following hospital discharge. Keywords: annular closure, complications, herniation, lumbar discectomy, randomized controlled trial, reoperation

Coral bleaching is a well-documented and increasingly widespread phenomenon in reefs across the globe, yet there has been relatively little research on the implications for reef water column microbiology and biogeochemistry. A mesocosm heating experiment and bottle incubation compared how unbleached and bleached corals alter dissolved organic matter (DOM) exudation in response to thermal stress and subsequent effects on microbial growth and community structure in the water column. Thermal stress of healthy corals tripled DOM flux relative to ambient corals. DOM exudates from stressed corals (heated and/or previously bleached) were compositionally distinct from healthy corals and significantly increased growth of bacterioplankton, enriching copiotrophs and putative pathogens. Together these results demonstrate how the impacts of both short-term thermal stress and long-term bleaching may extend into the water column, with altered coral DOM exudation driving microbial feedbacks that influence how coral reefs respond to and recover from mass bleaching events.

Pacific Arts N.S. Vol. 24, No. 1 (2024) Full Issue

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