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Karin ATGM Wasmann,1 Charlotte EL Klaver,1 Jarmila DW van der Bilt,1,2 Susan van Dieren,3 Iris D Nagtegaal,4 Cornelis JA Punt,5 Bert van Ramshorst,6 Albert M Wolthuis,2 Johannes HW de Wilt,7 André D’Hoore,2 Hjalmar C van Santvoort,6 Pieter J Tanis11Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands; 2Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium; 3Clinical Research Unit, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands; 4Department of Pathology, Radboud University Medical Centre, GA 6525, Nijmegen, The Netherlands; 5Department of Medical Oncology, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands; 6Department of Surgery, St. Antonius Hospital, CM 3435, Nieuwegein, The Netherlands; 7Department of Surgery, Radboud University Medical Centre, GA 6525, Nijmegen, The NetherlandsPurpose: The aim of this study was to evaluate the impact of a laparoscopic approach on long-term oncological outcomes in curative intent surgery for pT4 colon cancer, in both overall and stratified subgroups with distinct clinical entities.Patients and methods: Patients with a pT4N0-2M0 colon cancer from four centers between 2000 and 2014 were included. Laparoscopic and open approaches were compared according to the intention-to-treat principle. Propensity scores were used to adjust for baseline differences between the groups in three manners: i) as a linear predictor in a Cox regression model, ii) to create a 1:1 matched cohort, and iii) to stratify patients into four groups with an increasing chance of receiving laparoscopy.Results: In total, 424 patients were included. After 1:1 matching, a laparoscopic approach correlated with higher rates of radical resection, lower morbidity, and a higher percentage of patients receiving adjuvant chemotherapy. This translated into better 5-year disease-free survival (52% vs 40%, HR 0.70; 95% CI 0.50–0.96) and 5-year overall survival (68% vs 57%, HR 0.66; 95% CI 0.43–0.99). These results were confirmed in the other two propensity score analyses. In the multivariable models, adjuvant chemotherapy remained independently associated with better survival, whereas surgical approach lost significance.Conclusions: In locally advanced colon cancer, an intentional laparoscopic approach in experienced hands seems to decrease morbidity and to increase the proportion of patients receiving adjuvant chemotherapy. Receiving adjuvant chemotherapy was independently associated with improved survival.Keywords: T4 colon cancer, laparoscopy, lower GI

Up to 80% of Parkinson's disease patients develop dementia, but time to dementia varies widely from motor symptom onset. Dementia with Lewy bodies presents with clinical features similar to Parkinson's disease dementia, but cognitive impairment precedes or coincides with motor onset. It remains controversial whether dementia with Lewy bodies and Parkinson's disease dementia are distinct conditions or represent part of a disease spectrum. The biological mechanisms underlying disease heterogeneity, in particular the development of dementia, remain poorly understood, but will likely be the key to understanding disease pathways and, ultimately, therapy development. Previous genome-wide association studies in Parkinson's disease and dementia with Lewy bodies/Parkinson's disease dementia have identified risk loci differentiating patients from controls. We collated data for 7804 patients of European ancestry from Tracking Parkinson's, The Oxford Discovery Cohort, and Accelerating Medicine Partnership-Parkinson's Disease Initiative. We conducted a discrete phenotype genome-wide association study comparing Lewy body diseases with and without dementia to decode disease heterogeneity by investigating the genetic drivers of dementia in Lewy body diseases. We found that risk allele rs429358 tagging APOEe4 increases the odds of developing dementia, and that rs7668531 near the MMRN1 and SNCA-AS1 genes and an intronic variant rs17442721 tagging LRRK2 G2019S on chromosome 12 are protective against dementia. These results should be validated in autopsy-confirmed cases in future studies.

Despite its high prevalence among dementias, Lewy body dementia (LBD) remains poorly understood with a limited, albeit growing, evidence base. The public-health burden that LBD imposes is worsened by overlapping pathologies, which contribute to misdiagnosis, and lack of treatments. For this report, we gathered and analyzed public-domain information on advocacy, funding, research outputs, and the therapeutic pipeline to identify gaps in each of these key elements. To further understand the current gaps, we also conducted interviews with leading experts in regulatory/governmental agencies, LBD advocacy, academic research, and biopharmaceutical research, as well as with funding sources. We identified wide gaps across the entire landscape, the most critical being in research. Many of the experts participated in a workshop to discuss the prioritization of research areas with a view to accelerating therapeutic development and improving patient care. This white paper outlines the opportunities for bridging the major LBD gaps and creates the framework for collaboration in that endeavor. HIGHLIGHTS: A group representing academia, government, industry, and consulting expertise was convened to discuss current progress in Dementia with Lewy Body care and research. Consideration of expert opinion,natural language processing of the literature as well as publicly available data bases, and Delphi inspired discussion led to a proposed consensus document of priorities for the field.

A speaker's use of language is one of the most important indicators in detecting deception. To date, however, little research has focused on grammatical cues used in deceitful statements. One such cue is evidentiality which is the grammatical encoding for the source of information; i.e., whether the speaker has direct or indirect access to what they assert. This study investigates whether and how evidentiality coding in Turkish, an evidential language, interacts with producing deceitful and truthful narratives. Deceptive retellings were notably longer and syntactically more complex compared to truthful counterparts. Our hypothesis of increased past forms in deception was confirmed, alongside a heightened use of direct evidential inflection (–DI) in deceptive conditions. This exploration sheds light on the nuanced relationship between grammatical evidentiality and deceptive language use.

As the title of The American Indian and the Problem of History suggest, this work has a historiographic emphasis. In the wake of revisionist trends of the 1970s, Indian historians face a number of knotty problems as they endeavor to avoid ethnocentric biases and to incorporate Native American sources and perspectives. Collectively, the papers in this volume assess the achievements and pitfalls of revisionist history and consider methods and goals for future scholarship. For Martin and many of the contributors, a principal concern is the need to integrate an understanding of the interplay between religion and the environment in writing Indian history. ‘What was their metaphysics? Everything we write about [native Americans],” says Martin, “should follow from this seminal question” (p.216). Having circulated copies of his article, ‘the metaphysics of Writing Indian history” (reprinted here as Chapter 1), martin asked for the “large contours” of Indian and white history and “what it all means” (p.5). he evoked a variety of searching responses from his eighteen distinguished contributors, including veteran historians Robert Berthofer, Jr., Wilcolm Washburn, Cornelius Jaenen, Mary Young, henry Dobyns, vine Deloria, Jr. , and a number of equally impressive, younger scholars. The essys range in style and content from Berkhofer’s excellent essay, ‘Cultural Pluralism Versus Ethnocentrism in the New Indian History,” to Neil Salisbury’s useful overview of Indian prehistory, to Gerald Vizenor’s mythic satire, “Socioacupunture: Mythic Reversals and Striptease in four Scenes,” making provocative reading.

Massive Open Online Courses (MOOCs) are considered learning environments that eliminate many learning barriers. Online courses in MOOCs have become an opportunity for everyone during the lockdown of the COVID-19 outbreak. However, usability issues may cause problems such as high dropout rates and lack of learner's motivation. Therefore, in this study, the usability of Coursera, one of the most known MOOCs in the world, was evaluated. The evaluation was performed with ISO 9241-11 standard. The environment's effectiveness, efficiency, and satisfaction were evaluated with the authentic tasks requested to be done in Coursera. Additionally, the findings were supported by eye-tracking metrics such as fixation duration, fixation counts, heat maps, and gaze plots. Twelve individuals (six females, six males) participated in the authentic tasks, and three individuals (two females, one male) participated in the eye-tracking phase. Results of the study revealed that most participants successfully performed the authentic tasks and are generally satisfied with the usability of the environment. However, considering eye-tracking findings and Coursera Usage Satisfaction Survey, some usability problems such as inadequate language support and the difficulty of using the search feature emerged. In the end, possible reasons were discussed, and the suggestions were presented for usability improvements.

Abstract Background Vaccination is one of the greatest tools for individuals to stay healthy. Individuals are, however, often exposed to misinformation via digital and social media, and thus, may miss the opportunity to develop scientific knowledge about vaccines and trust in relevant stakeholders. This has a damaging impact on vaccine confidence. Understanding vaccine confidence is particularly important in North Dakota, where vaccination rates are lower than national averages. Objectives The objectives of this research are to examine the association between vaccine confidence and three potential sources of it, namely, trust, vaccine knowledge, and vaccine information sources and to investigate the relative strength of three vaccine confidence sources, while accounting for covariates. Methods Students (n = 517, 56.6%) and staff and faculty (n = 397, 43.4%) at the University of North Dakota (n = 914) completed an online survey. Logistic regressions estimated odds ratios (OR) and 95% confidence intervals (CI) for associations among trust in doctors, family/friends, government health agencies, charitable organizations, and religious organizations, vaccine knowledge, vaccine information sources as well as vaccine confidence, accounting for gender, race, marital status, age, religion, political ideology, education, and health status. Results The mean age of participants was 29.43 years (SD = 13.48). Most were females (71.6%) and white (91.5%). Great trust in doctors (OR = 3.29, p

We characterized the role of structural variants, a largely unexplored type of genetic variation, in two non-Alzheimer's dementias, namely Lewy body dementia (LBD) and frontotemporal dementia (FTD)/amyotrophic lateral sclerosis (ALS). To do this, we applied an advanced structural variant calling pipeline (GATK-SV) to short-read whole-genome sequence data from 5,213 European-ancestry cases and 4,132 controls. We discovered, replicated, and validated a deletion in TPCN1 as a novel risk locus for LBD and detected the known structural variants at the C9orf72 and MAPT loci as associated with FTD/ALS. We also identified rare pathogenic structural variants in both LBD and FTD/ALS. Finally, we assembled a catalog of structural variants that can be mined for new insights into the pathogenesis of these understudied forms of dementia.

Introduction Inadequate treatment of enlarged lateral lymph nodes (LLNs) in rectal cancer patients is associated with an increased lateral local recurrence (LLR) risk, despite neoadjuvant treatment and total mesorectal excision (TME) surgery. There is a promising role for LLN dissection (LLND) to lower this risk, but this challenging procedure requires appropriate training. This study protocol describes a prospective evaluation of oncological outcomes after standardised treatment based on multidisciplinary training, thereby aiming for a 50% reduction in LLR rate.Methods and analysis A prospective registration study will be opened in hospitals in which the involved multidisciplinary team members (radiologists, radiation oncologists, surgeons and pathologists) have received dedicated training to enhance knowledge and awareness of LLNs and in which standardised treatment including LLND has been implemented. Patients with rectal cancer and at least one enlarged LLN (short-axis ≥7.0 mm), or intermediate LLN (short-axis 5.0–6.9 mm) with at least one malignant feature on primary MRI, evaluated by a trained radiologist, are eligible. Patients will undergo neoadjuvant treatment by trained radiation oncologists, followed by TME surgery in combination with a minimally invasive, nerve-sparing LLND performed by trained surgeons. LLND specimens are evaluated by trained pathologists or grossing assistants. The primary outcome is LLR rate 3 years postoperatively. Secondary outcomes are morbidity, disease-free survival, overall survival and quality of life. To demonstrate a significant reduction in LLR rate from 13% (based on historical control data) to 6% after optimised treatment, 200 patients with enlarged LLNs are required.Ethics and dissemination The medical ethics board of the Vrije Universiteit Medical Centre (VUMC), the Netherlands, approved the study on 23 November 2022 (reference: 2021.0524). Participating centres must obtain local approval and participants are required to provide written informed consent. Results obtained from this study will be communicated via peer-reviewed medical journals and presentations at conferences.Trail registration number NCT04486131, 24 July 2020, https://clinicaltrials.gov/ct2/show/NCT04486131.

Abstract Dementia with Lewy bodies (DLB) is a neurodegenerative condition often co-occurring with Alzheimer’s disease (AD) pathology. Characterizing white matter tissue microstructure using Neurite Orientation Dispersion and Density Imaging (NODDI) may help elucidate the biological underpinnings of white matter injury in individuals with DLB. In this study, diffusion tensor imaging (DTI) and NODDI metrics were compared in 45 patients within the dementia with Lewy bodies spectrum (mild cognitive impairment with Lewy bodies (n = 13) and probable dementia with Lewy bodies (n = 32)) against 45 matched controls using conditional logistic models. We evaluated the associations of tau and amyloid-β with DTI and NODDI parameters and examined the correlations of AD-related white matter injury with Clinical Dementia Rating (CDR). Structural equation models (SEM) explored relationships among age, APOE ε4, amyloid-β, tau, and white matter injury. The DLB spectrum group exhibited widespread white matter abnormalities, including reduced fractional anisotropy, increased mean diffusivity, and decreased neurite density index. Tau was significantly associated with limbic and temporal white matter injury, which was, in turn, associated with worse CDR. SEM revealed that amyloid-β exerted indirect effects on white matter injury through tau. We observed widespread disruptions in white matter tracts in DLB that were not attributed to AD pathologies, likely due to α-synuclein-related injury. However, a fraction of the white matter injury could be attributed to AD pathology. Our findings underscore the impact of AD pathology on white matter integrity in DLB and highlight the utility of NODDI in elucidating the biological basis of white matter injury in DLB.

In this review, we summarize the current knowledge on sex differences in dementia with Lewy bodies (DLB) relating to epidemiology, clinical features, neuropathology, biomarkers, disease progression, and caregiving. While many studies show a higher DLB prevalence in men, this finding is inconsistent and varies by study approach. Visual hallucinations may be more common and occur earlier in women with DLB, whereas REM sleep behavior disorder may be more common and occur earlier in men. Several studies report a higher frequency of parkinsonism in men with DLB, while the frequency of fluctuations appears similar between sexes. Women tend to be older, have greater cognitive impairment at their initial visit, and are delayed in meeting DLB criteria compared to men. Women are also more likely to have Lewy body disease with co-existing AD-related pathology than so-called pure Lewy body disease, while men may present with either. Research is mixed regarding the impact of sex on DLB progression. Biomarker and treatment research assessing for sex differences is lacking. Women provide the majority of caregiving in DLB but how this affects the caregiving experience is uncertain. Gaining a better understanding of sex differences will be instrumental in aiding future development of sex-specific strategies in DLB for early diagnosis, care, and drug development.

Brevibacillus laterosporus, an endospore-forming, aerobic, Gram-positive bacillus, is not only a potential biocontrol agent against plant pathogens but also a rare cause of human infection. Its pathogenicity in humans, especially in immunocompetent individuals, is still not fully understood. Skin infections caused by B. laterosporus are typically opportunistic, entering the skin through cuts, wounds, or other breaches in the skin’s protective barrier, as in the case presented here.

Switching from face-to-face learning to mandatory online education during the coronavirus pandemic brought much uncertainty and new experiences for undergraduate students who were unfamiliar with that type of learning. This research aimed to identify perceptions and experiences of preservice [PST] teachers about taking science courses online in the teacher education programs during the COVID-19 lockdown. 180 PSTs voluntarily participated in this study from three public universities located in different regions of Turkey. These PSTs enrolled in seven different science and science education courses, including Science, Technology, and Society-- Science Teaching Methods, Introduction to Science, Science and Technology Teaching, Radiation and Health Physics, Science Curriculum, Application of Science in Technology. The data was collected via online questionnaires, which were applied before and after online learning and analyzed via deductive and inductive content analysis. As a result, we identified six different categories, representing their perspectives, including concerns, expectations, opportunities, threats, motivation/interests, and beliefs. In each category, PSTs' responses were given with different codes, which were gathered under sub-categories. The results indicated that initially, PSTs had many expectations/opportunities, concerns, and beliefs toward the online education process. While some of these expectations, beliefs, and opportunities were fulfilled during the online learning process, some fundamental issues caused various obstacles in this process as well. [The page range (2-25) on the .pdf is incorrect. The correct page range is p2-26.]

Sidewalk infrastructure presence is a key indicator of pedestrian safety and walkability for neighborhoods in cities throughout the United States. The existence and condition of sidewalk infrastructure, however, is not prioritized as much as motor vehicle infrastructure. Many cities lack sustained maintenance and operations programs for sidewalk infrastructure and comprehensive datasets covering the locations and distributions of sidewalk infrastructure, limiting the ability to develop such programs. This work refines prior sidewalk infrastructure network generation techniques, contributing new methods to identify sidewalk infrastructure presence.QA/QC efforts were conducted for in Atlanta’s sidewalk network by correcting errors identified in input data. Error identification and correction times were comprehensively tracked and used to estimate future labor costs. A Custom application with online access to Bing Maps Streetside and aerial imagery was developed to allow technicians to verify sidewalk presence data, which were joined to the structural sidewalk network and associated with adjacent parcels. Cost of ownership of Atlanta’s sidewalk infrastructure over an 80-year management period is then broken down by asset type and allocated in part to property owners directly adjacent to the applicable infrastructure, while remaining costs are recovered through a proportional increase in property tax millage rates. Sidewalk network estimates developed in previous Atlanta research efforts decreased sidewalk network mileage by 12% (386 miles), post-QA/QC. Regression analysis of error correction activity and labor data indicates gaps between tax parcels and misplacement of intersection centroids significantly increased QA/QC labor costs. Overall, 46% of Atlanta’s potential sidewalk links were present(i.e., along property superblock boundaries), with significant clustering in the city’s oldest neighborhoods. Hence, sidewalk repair and maintenance costs accrue disproportionately to these areas. Sidewalk infrastructure costs across neighborhoods also differ considerably, depending on whether estimates account for existing sidewalk infrastructure. The annual cost burden on property owners to implement a program to fund sustainable sidewalks (lifecycle assessment) by increasing property tax millage rates varies significantly across household income and ethnicity. The research suggests that sustainable sidewalk infrastructure assessments should consider spatial and demographic disparities in cost allocation (i.e., equity) for any proposed pedestrian infrastructure asset management program.View the NCST Project Webpage

The APOE locus is strongly associated with risk for developing Alzheimer's disease and dementia with Lewy bodies. In particular, the role of the APOE ε4 allele as a putative driver of α-synuclein pathology is a topic of intense debate. Here, we performed a comprehensive evaluation in 2466 dementia with Lewy bodies cases versus 2928 neurologically healthy, aged controls. Using an APOE-stratified genome-wide association study approach, we found that GBA is associated with risk for dementia with Lewy bodies in patients without APOE ε4 (P = 6.58 × 10-9, OR = 3.41, 95% CI = 2.25-5.17), but not with dementia with Lewy bodies with APOE ε4 (P = 0.034, OR = 1.87, 95%, 95% CI = 1.05-3.37). We then divided 495 neuropathologically examined dementia with Lewy bodies cases into three groups based on the extent of concomitant Alzheimer's disease co-pathology: pure dementia with Lewy bodies (n = 88), dementia with Lewy bodies with intermediate Alzheimer's disease co-pathology (n = 66) and dementia with Lewy bodies with high Alzheimer's disease co-pathology (n = 341). In each group, we tested the association of the APOE ε4 against the 2928 neurologically healthy controls. Our examination found that APOE ε4 was associated with dementia with Lewy bodies + Alzheimer's disease (P = 1.29 × 10-32, OR = 4.25, 95% CI = 3.35-5.39) and dementia with Lewy bodies + intermediate Alzheimer's disease (P = 0.0011, OR = 2.31, 95% CI = 1.40-3.83), but not with pure dementia with Lewy bodies (P = 0.31, OR = 0.75, 95% CI = 0.43-1.30). In conclusion, although deep clinical data were not available for these samples, our findings do not support the notion that APOE ε4 is an independent driver of α-synuclein pathology in pure dementia with Lewy bodies, but rather implicate GBA as the main risk gene for the pure dementia with Lewy bodies subgroup.

Awareness of executive functioning and its relevance to both occupational participation and special education is expanding. This study describes how school-based occupational therapists address executive functioning in practice and determined if this differs from traditional areas. Fourteen occupational therapists from four districts in Michigan completed the 36-item online survey consisting of closed and open-ended questions. A majority of these participants agreed that executive functioning impacts school function and occupational therapists should address it in school; yet, only 33% provided intervention using this lens and 77% indicated this as the area they feel least prepared to address in school-based practice. Executive function practice significantly differed from handwriting (p < 0.05), sensory (p < 0.01), and fine motor competency (p < 0.01); fine motor and sensory evaluation (p < 0.05); and handwriting intervention (p < 0.05). Participants described their role with executive functioning as collaborative, supplemental to enhance participation, and applicable to functional organization tasks. Although some occupational therapists are embracing an occupation-based process explicitly considering executive functioning, a majority need continued education, role clarity, and advocacy to more intentionally align their team's services with emerging best practice.

Across the United States, State Education Agencies (SEAs) are using tiered strategies, such as Multi-Tiered System of Supports (MTSS) frameworks, to ensure that all students, including diverse learners, receive equal, high-quality education. However, little is known about the extent to which SEAs are encouraging use of MTSS to address the needs of students with moderate-to-severe cognitive disabilities. The present study aimed to examine how SEAs conceptualize and support the implementation of MTSS as an approach to inclusionary education. Data were collected through interviews with key informants in SEAs across 19 states. Members of the research team identified and coded portions of interview transcripts that related to legal requirements for MTSS at the state level, local control as an enabler of or impediment to states' MTSS work, and levels of inclusiveness in MTSS provisions. Three criteria emerged as important to MTSS inclusiveness: (1) inclusiveness in the espoused MTSS scope; (2) extensiveness of inclusive MTSS practices; and (3) specific application of MTSS to students with significant cognitive disabilities. Analyses showed variability across states regarding their commitment to an MTSS approach across the three domains of inclusiveness. Findings showed the value of developing and disseminating MTSS models offering tiered support for all students and the need for SEA offices to engage in collaborative efforts to support the implementation of inclusive MTSS models. The study also raised questions about the role of rhetoric (i.e., "All means all") in promoting or hindering increased inclusiveness in MTSS implementation.

This paper investigates the effects of three different types of prewriting instruction on Turkish students' L2 writing production capabilities. This mixed method study was carried out with 45 Turkish EFL students enrolled at a state university. Students were allocated into three groups randomly. In the control group the prewriting phase was carried out with monologic instruction in L2, while in one of the experimental groups, it was done with dialogic instruction in L2 and in the second experimental group, dialogic instruction was conducted in L1. Data were collected by means of pre-and post-writing tasks of the students and semi-structured interviews, and analyzed with Kruskal-Wallis and Mann Whitney tests and through pattern coding, respectively. The statistical results indicated that the group who used their L1 during pre-writing stage with the help of dialogic instruction had higher mean scores than the group who was instructed monologically and the group who was instructed through dialogic instruction in L2.

Effective online teaching and learning requires a carefully designed classroom that promotes student engagement with faculty, peers and course content. This research included an investigation of the importance of "faculty-student communication and collaboration"; "student-student communication and collaboration"; "active learning techniques"; "prompt feedback"; "appropriate time for tasks"; "high performance expectations"; and "respect for diverse learning styles" ("preferences") (Chickering and Ehrmann 1996) to faculty in their online teaching and to alumni in their online learning. The participants were 14 college faculty and 111 alumni, from the same graduate program. A 45-item Likert survey and two open-ended questions were presented to the participants to explore the important factors contributing to their online teaching and learning. The results demonstrated that holding students to high standards of performance, academic honesty and professional conduct was the most important factor to both faculty in their online teaching and alumni in their online learning. Additionally, alumni valued engagement with their faculty more than engagement with other students or course content. Students need an online instructor who is organised and communicative in the online classroom, and faculty need a solidly designed online classroom, with engaged students who are timely in their work. An analysis of the findings with specific application to online teaching and learning is presented in this article.

Introduction: Suture tension has a direct influence on the sutured tissue. For abdominal wall closure, suture tension should be optimal without causing tissue necrosis, which can result in surgical site infection or incisional hernia. The purpose of the present study is to evaluate a device that can measure suture tension in-situ and in real-time. Materials and methods: A cheap, commercially available analog-to-digital converter was used, in conjunction with a force sensing resistor. A sensor probe housing was designed and 3D-printed. In order to test the sensor, a mechanical, computer controlled human abdominal wall model called the AbdoMAN was used. Results: An implantable suture tension sensor was developed, keeping cost-effectiveness in mind. This sensor can translate tension in the suture into a downward force, applied to the force sensing resistor. The sensor's raw readout was characterized using a set of weights, from which a formula correlating the readout to a specific force, was derived. Preliminary validation was successfully performed using the AbdoMANmodel, which showed a progressive rise in suture tension when the intra-abdominal pressure was artificially increased over time. Conclusion: The implantable suture tension sensor appeared to be capable of recording real time changes in suture tension, and the. validation process of this sensor has been initiated. With the information from devices like this, a much better understanding of the issues at play in the development of incisional hernia can be gained.

Background and purpose Recent research has highlighted non-operative management (NOM) as a viable alternative for frail older adults with hip fractures in the final phase of life. This study aims to guide Dutch physicians and hospitals nationwide in a standardised implementation of shared decision-making regarding surgery or NOM in selected frail older adults with a hip fracture.Methods and analysis The patient population for implementation includes frail older adults aged ≥70 years with an acute proximal femoral fracture, nursing home care or a similar level of care elsewhere and at least one additional criterion (ie, malnutrition, severe mobility impairment or ASA≥4). The 2-year implementation study will be conducted in four phases. In phases 1 and 2, barriers and facilitators for implementation will be identified and an implementation protocol, educational materials and patient information will be developed. Phase 3 will involve an implementation pilot in 14 hospitals across the Netherlands. The protocol and educational material will be improved based on healthcare provider and patient experiences gathered through interviews. Phase 4 will focus on upscaling to nationwide implementation and the effect of the implementation on NOM rate will be measured using data from the Dutch Hip Fracture Audit.Ethics and dissemination The study was exempted by the local Medical Research Ethics Committee (MEC-2023-0270, 10 May 2023) and Medical Ethics Committee United (W23.083, 26 April 2023). The study’s results will be submitted to an open access international peer-reviewed journal. Its protocols, tools and results will be presented at several national and international academic conferences of relevant orthogeriatric (scientific) associations.Trial registration number NCT06079905.

Introduction Incisional hernia (IH) is a prevalent and potentially dangerous complication of abdominal surgery, especially in high-risk groups. Mesh reinforcement of the abdominal wall has been studied as a potential intervention to prevent IHs. Randomised controlled trials (RCTs) have demonstrated that prophylactic mesh reinforcement after abdominal surgery, in general, is effective and safe. In patients with abdominal aortic aneurysm (AAA), prophylactic mesh reinforcement after open repair has not yet been recommended in official guidelines, because of relatively small sample sizes in individual trials. Furthermore, the identification of subgroups that benefit most from prophylactic mesh placement requires larger patient numbers. Our primary aim is to evaluate the efficacy and effectiveness of the use of a prophylactic mesh after open AAA surgery to prevent IH by performing an individual patient data meta-analysis (IPDMA). Secondary aims include the evaluation of postoperative complications, pain and quality of life, and the identification of potential subgroups that benefit most from prophylactic mesh reinforcement.Methods and analysis We will conduct a systematic review to identify RCTs that study prophylactic mesh placement after open AAA surgery. Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase, Web of Science Core Collection and Google Scholar will be searched from the date of inception onwards. RCTs must directly compare primary sutured closure with mesh closure in adult patients who undergo open AAA surgery. Lead authors of eligible studies will be asked to share individual participant data (IPD). The risk of bias (ROB) for each included study will be assessed using the Cochrane ROB tool. An IPDMA will be performed to evaluate the efficacy, with the IH rate as the primary outcome. Any signs of heterogeneity will be evaluated by Forest plots. Time-to-event analyses are performed using Cox regression analysis to evaluate risk factors.Ethics and dissemination No new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publications in peer-reviewed journals and summaries posted online.PROSPERO registration number CRD42022347881.