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Claudia Cavaggion,1 Alejandro Luque-Suarez,2,3 Lennard Voogt,4,5 Birgit Juul-Kristensen,6 Guy Wollants,7 Lucas Beke,7 Erik Fransen,8 Filip Struyf1 1Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; 2Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain; 3Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain; 4Rotterdam University of Applied Sciences, Department of Physical Therapy Studies and Research Centre for Health Care Innovations, Rotterdam, the Netherlands; 5Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; 6Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; 7Groepspraktijk Beke & Wollants, Hove, Belgium; 8Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, BelgiumCorrespondence: Alejandro Luque-Suarez, Faculty of Health Sciences, Universidad de Malaga, Arquitecto Penalosa s/n, Malaga, 29002, Spain, Email aluques@uma.esPurpose: Exercise therapy is the first-line treatment in rotator cuff-related shoulder pain (RCRSP), and diverse types of exercise seem effective. However, it is not still clear if painful exercise should be allowed or avoided during exercises. The objective of this study was to investigate if exercise into pain is more effective than no pain in RCRSP.Patients and Methods: A randomized controlled trial was conducted in a physiotherapy clinic in Belgium. Forty-three participants with chronic RCRSP were randomly allocated to G1 (exercising into pain) or G2 (exercising without pain) in a 12-week intervention with 6-month follow-up. Primary outcome was the Shoulder Pain and Disability Index (SPADI); secondary outcomes were pain intensity, fear-avoidance beliefs, fear of pain, quality of life, strength, and range of motion. Outcomes were measured at baseline (T0), after 9 weeks (T1), 12 weeks (T2), and 6 months (T3) from the first session and analysed with linear mixed models.Results: No between-group difference in SPADI (time-by-group interaction, p = 0.25) up to 6 months was found, with mean difference (G1-G2) at T1 = 5.78 (CI95%: − 3.43,14.59; p = 0.33), at T2 = 0.93 (CI95%: − 7.20,9.05; p = 0.82), at T3 = 4.15 (CI95%: − 2.61,10.92; p = 0.33). No between-group differences were found for any other outcomes.Conclusion: Pain provocation seems not to be necessary in RCRSP for achieving successful treatment effect in pain and disability reduction, fear-related beliefs, and quality of life up to 6 months.Trial Registration: ClinicalTrials.gov NCT04553289.Keywords: shoulder pain, rehabilitation, physical therapy modalities, shoulder impingement syndrome, exercise therapy

Team coordination is essential for effective performance during critical, stressful events. To better understand processes and states involved at multiple levels of team coordination, we assessed the correspondence between low- and high-level coordination in teams participating in simulation-based medical team training. We computed a measure of low-level team coordination with Multidimensional Recurrence Quantification Analysis, applied to arm movement, heart rate, and skin conductance data. High-level team coordination was captured by annotating video recordings for explicit and implicit, information and action coordination. Three linear mixed-effects model were run, each predicting a type of low-level coordination, based on high-level coordination annotations, accounting for multiple observations per team. Our findings showed that, compared to periods without annotated coordination, explicit- and implicit- information coordination corresponded to significantly different low-level team coordination across each of the studied modalities. Further research is required to assess additional factors related to the temporal variability observed in low-level coordination.

Abstract Background The physical and the social environment are important predictors of healthy weight, especially in low socioeconomic position (SEP) neighborhoods. Many Dutch municipalities have implemented a healthy weight approach (HWA). Yet, there is room for improvement. This system science study examined what influences the utilization of HWA facilities and activities, and what aspects can help to achieve a desired systems change (also called leverage point themes (LPTs)) in the HWA system as perceived by citizens living in low SEP neighborhoods. Method All research phases were performed with four citizens co-researchers. Forty-seven citizens living in low SEP neighborhoods were semi-structurally interviewed about the neighborhood HWA facilities and municipal HWA activities. A rapid coding qualitative analysis approach was applied per topic. The topics were citizens’ healthy living description, personal circumstances, and satisfaction with foot and cycle paths, sports facilities, playgrounds, green spaces, museums and theaters, community centers, churches, healthcare, school, food supplies, contact with neighborhood, unfamiliar and/or unused activities, familiar and used activities, unavailable but desired (lacking) activities, and reaching citizens. Results The utilization of HWA facilities and activities was influenced by the overarching themes of social cohesion, familiarity, reaching citizens, maintenance, safety, physical accessibility, financial accessibility, social accessibility, fit with personal context, and fit with the neighborhood’s specific needs. Different overarching themes stood out across different facilities and activities. LPTs indicated the overarching themes needed in combination with one another for a specific activity or facility to increase utilization. For example, the LPT regarding foot and cycle paths was “accessible, safe, and maintained foot and cycle paths”. The LPTs regarding familiar and used activities were “customized activities; information provision (e.g., about possibilities to join without paying); social contact, meeting others, and everyone feels included”. Conclusion Conducting inclusive qualitative research from a systems perspective among citizens living in low SEP neighborhoods has contributed valuable insights into their needs. This enables practical implementation of HWAs by providing a deeper understanding of the LPTs within the HWA system. LPTs can help HWA stakeholders to further develop current HWAs toward systems approaches. Future research could study the leverage points that may contribute to LPT implementation.

Background: Maternity care increasingly aims to achieve Shared Decision-making (SDM), yet seemingly not to the benefit of clients with low health literacy (HL). We developed an SDM training for healthcare professionals (HCPs) and a conversation aid to support HL-sensitive SDM in maternity care. Methods: The training and conversation aid were based on previous needs assessments and expert consultation, and were developed in co-creation with clients (n = 15) and HCPs (n = 7). Usability, acceptability and comprehension of the conversation aid were tested among new clients (n = 14) and HCPs (n = 6). Acceptability of the training was tested among midwifery students (n = 5). Results: In the co-creation sessions, clients reported to expect that their midwife becomes acquainted with their general values, priorities and daily context. Clients also emphasized wanting to be supported in their preferred decisional role. User test interviews showed that clients and HCPs were positive towards using the conversation aid, but also apprehensive about the time it required. The user test of the training showed that more attention was needed for recognizing and adapting information provision to clients' HL level. Conclusion and innovation: The newly developed conversation aid and training have potential to support HCPs and clients in HL-sensitive SDM.

IntroductionThe pervasive denial of death in modern society has created an unbalanced relationship with death that gets in the way of living a full life. To address this problem, the Lancet Commission on the Value of Death recently proposed principles of a healthier scenario for the future. In this ‘realistic utopia’, death is recognized as having value, and conversations about death and dying have become common. The present research examined if art could help to decrease death denial and increase life appreciation.MethodsAn art installation invited visitors to confront thoughts of their own death in a guided meditation by visualizing the decay of their own dead body. Visitors’ responses were compared to those of a standard death reflection group and a neutral control group (N=229) at two time points. Feelings of being moved, connectedness to a higher power, and life appreciation were assessed immediately (T1); death reflection and life appreciation were assessed two weeks later (T2) (N=105).ResultsAt T1, the art installation induced higher levels of being moved and connectedness to a higher power than the two control groups. At T2, the art installation induced more lingering reflection than the two control groups. Lingering reflection, in turn, increased appreciation of life.DiscussionWe show that art can be harnessed to promote a more balanced relationship with death, and greater appreciation of life. The art installation provided individuals with concrete, and more encompassing simulations of what death could be like. By placing death in this bigger perspective, the art installation encouraged conscious death reflection. Such a connected perspective is often lacking, but direly needed, in healthcare and in larger society.

Lifetimes of excited states in the very exotic nuclides 108Zr68 and 110Zr70 were measured for the first time applying high-resolution in-beam γ-ray spectroscopy at relativistic energies. The experiment was carried out at the Radioactive Isotope Beam Factory in RIKEN, using nucleon removal reactions of radioactive Nb ions to produce 108Zr and 110Zr. Emitted γ rays from the excited states were measured by the High-resolution Cluster Array at RIBF (HiCARI) and lifetimes were extracted from the observed line shapes caused by relativistic Doppler-shift effects. In addition to the new lifetime information, the precision of the E(21+) and R4/2=E(41+)/E(21+) values of 110Zr could be significantly improved. The low-lying 22+ states in both nuclei are also newly observed, which are indicative of the triaxiality. The various physical quantities were compared with theoretical models to investigate the collectivity in Zr isotopes towards N=70. Together the experimental and theoretical results point at a reduction of the axial deformation while triaxial collectivity increases.

Abstract Mononuclear phagocytes (MNP), including macrophages and dendritic cells form an essential component of primary responses to environmental hazards and toxic exposures. This is particularly important in disease conditions such as asthma and allergic airway disease, where many different cell types are present. In this study, we differentiated CD34+ haematopoietic stem cells towards different populations of MNP in an effort to understand how different cell subtypes present in inflammatory disease microenvironments respond to the common allergen house dust mite (HDM). Using single cell mRNA sequencing, we demonstrate that macrophage subtypes MCSPP1+ and MLCMARCO+ display different patterns of gene expression after HDM challenge, noted especially for the chemokines CXCL5, CXCL8, CCL5 and CCL15. MLCCD206Hi alternatively activated macrophages displayed the greatest changes in expression, while neutrophil and monocyte populations did not respond. Further work investigated how pollutant diesel exhaust particles could modify these transcriptional responses and revealed that CXC but not CC type chemokines were further upregulated. Through the use of diesel particles with adsorbed material removed, we suggest that soluble pollutants on these particles are the active constituents responsible for the modifying effects on HDM. This study highlights that environmental exposures may influence tissue responses dependent on which MNP cell type is present, and that these should be considerations when modelling such events in vitro. Understanding the nuanced responsiveness of different immune cell types to allergen and pollutant exposure also contributes to a better understanding of how these exposures influence the development and exacerbation of human disease.

Abstract Objectives This study aimed to evaluate the potential clinical value of a new brain age prediction model as a single interpretable variable representing the condition of our brain. Among many clinical use cases, brain age could be a novel outcome measure to assess the preventive effect of life-style interventions. Methods The REMEMBER study population (N = 742) consisted of cognitively healthy (HC,N = 91), subjective cognitive decline (SCD,N = 65), mild cognitive impairment (MCI,N = 319) and AD dementia (ADD,N = 267) subjects. Automated brain volumetry of global, cortical, and subcortical brain structures computed by the CE-labeled and FDA-cleared software icobrain dm (dementia) was retrospectively extracted from T1-weighted MRI sequences that were acquired during clinical routine at participating memory clinics from the Belgian Dementia Council. The volumetric features, along with sex, were combined into a weighted sum using a linear model, and were used to predict ‘brain age’ and ‘brain predicted age difference’ (BPAD = brain age–chronological age) for every subject. Results MCI and ADD patients showed an increased brain age compared to their chronological age. Overall, brain age outperformed BPAD and chronological age in terms of classification accuracy across the AD spectrum. There was a weak-to-moderate correlation between total MMSE score and both brain age (r = -0.38,p

Abstract Nonischaemic myocardial fibrosis is associated with cardiac dysfunction, malignant arrhythmias and sudden cardiac death. In the absence of a specific aetiology, its finding as late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging is often attributed to preceding viral myocarditis. Athletes presenting with ventricular arrhythmias often have nonischaemic LGE. Previous studies have demonstrated an adverse effect of exercise on the course of acute viral myocarditis. In this study, we have investigated, for the first time, the impact of endurance training on longer-term outcomes such as myocardial fibrosis and arrhythmogenicity in a murine coxsackievirus B3 (CVB)-induced myocarditis model. Male C57BL/6J mice (n = 72) were randomly assigned to 8 weeks of forced treadmill running (EEX) or no exercise (SED). Myocarditis was induced 2 weeks later by a single intraperitoneal injection with CVB, versus vehicle in the controls (PBS). In a separate study, mice (n = 30) were subjected to pretraining for 13 weeks (preEEX), without continuation of exercise during myocarditis. Overall, continuation of exercise resulted in a milder clinical course of viral disease, with less weight loss and better preserved running capacity. CVB-EEX and preEEX-CVB mice tended to have a lower mortality rate. At sacrifice (i.e. 6 weeks after inoculation), the majority of virus was cleared from the heart. Histological assessment demonstrated prominent myocardial inflammatory infiltration and cardiomyocyte loss in both CVB groups. Inflammatory lesions in the CVB-EEX group contained higher numbers of pro-inflammatory cells (iNOS-reactive macrophages and CD8+ T lymphocytes) compared to these in CVB-SED. Treadmill running during myocarditis increased interstitial fibrosis [82.4% (CVB-EEX) vs. 56.3% (CVB-SED); P = 0.049]. Additionally, perivascular and/or interstitial fibrosis with extensive distribution was more likely to occur with exercise [64.7% and 64.7% (CVB-EEX) vs. 50% and 31.3% (CVB-SED); P = 0.048]. There was a numerical, but not significant, increase in the number of scars per cross-section (1.9 vs. 1.2; P = 0.195), with similar scar distribution and histological appearance in CVB-EEX and CVB-SED. In vivo electrophysiology studies did not induce sustained monomorphic ventricular tachycardia, only nonsustained (usually polymorphic) runs. Their cumulative beat count and duration paralleled the increased fibrosis between CVB-EEX and CVB-SED, but the difference was not significant (P = 0.084 for each). Interestingly, in mice that were subjected to pretraining only without continuation of exercise during myocarditis, no differences between pretrained and sedentary mice were observed at sacrifice (i.e. 6 weeks after inoculation and training cessation) with regard to myocardial inflammation, fibrosis, and ventricular arrhythmogenicity. In conclusion, endurance exercise during viral myocarditis modulates the inflammatory process with more pro-inflammatory cells and enhances perivascular and interstitial fibrosis development. The impact on ventricular arrhythmogenesis requires further exploration.

Magnetic Resonance Imaging (MRI) offers strong soft tissue contrast but suffers from long acquisition times and requires tedious annotation from radiologists. Traditionally, these challenges have been addressed separately with reconstruction and image analysis algorithms. To see if performance could be improved by treating both as end-to-end, we hosted the K2S challenge, in which challenge participants segmented knee bones and cartilage from 8× undersampled k-space. We curated the 300-patient K2S dataset of multicoil raw k-space and radiologist quality-checked segmentations. 87 teams registered for the challenge and there were 12 submissions, varying in methodologies from serial reconstruction and segmentation to end-to-end networks to another that eschewed a reconstruction algorithm altogether. Four teams produced strong submissions, with the winner having a weighted Dice Similarity Coefficient of 0.910 ± 0.021 across knee bones and cartilage. Interestingly, there was no correlation between reconstruction and segmentation metrics. Further analysis showed the top four submissions were suitable for downstream biomarker analysis, largely preserving cartilage thicknesses and key bone shape features with respect to ground truth. K2S thus showed the value in considering reconstruction and image analysis as end-to-end tasks, as this leaves room for optimization while more realistically reflecting the long-term use case of tools being developed by the MR community.