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In a research setting (TRIDENT-2), Dutch pregnant women undergoing prenatal screening for trisomies 21, 18 and 13 with the Non-Invasive Prenatal Test (NIPT), are offered the choice to also receive information about incidental findings. In a recent report, the Health Council of the Netherlands has recommended to retain this option, but to only report those incidental findings that very probably will lead to serious health outcomes for the child. A working group has been appointed to draw up a guideline for this. In this article we argue that actively searching for desired 'incidental findings' in fact amounts to broadening the scope of the screening and that a justification of this choice is still lacking. A core issue is whether the benefits of such broader screening outweigh the drawback of inevitably also generating findings that do not fit in with the aim of the screening: providing meaningful reproductive choices.

The number of publications on the governance of research with human embryo-like structures (hELS), i.e., 3D aggregates of human (induced) pluripotent stem cells made to model early human development, is growing rapidly. Public involvement is called for in many of these publications, but studies on public perspectives towards this emerging field remain lacking due to its novelty. To reduce the gap in the literature and contribute to the ongoing scholarly debate, we conducted interviews with Dutch lay citizens, health law and health care professionals, and interviewees reasoning from prominent worldviews in the Netherlands. This article reports on these participants’ views about the conceptual and moral qualification of hELS. With regard to the conceptual qualification of hELS, participants believed it should provide a shorthand for their (dis)similarity to human embryos, but differences remained with regard to the features upon which this (dis)similarity should be based. With regard to the moral qualification of hELS, participants believed this should depend on whether or not hELS possessed the features they considered morally relevant, among which those associated with sentience and a potential for continuous human development. Taken together, these findings align well with the arguments and positions traditionally found in related ethical debates and the recently proposed recommendations for the governance of research with hELS specifically. As such, they may also help allay concerns about lay publics not being able to meaningfully participate in debates about the ethical ramifications of (novel) scientific developments.

Background Pulmonary Hypertension (PH) impacts negatively on patients’ health-related quality of life (HRQoL). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) was the first PH-specific and validated instrument for use in different languages worldwide. This report describes the adaptation and psychometric validation of the CAMPHOR into Brazilian Portuguese language. Methods The translation and validation process included a bilingual and lay panel translation; cognitive debriefing interviews; psychometric testing in two repeated times assessing internal consistency, reproducibility and validity of the questionnaire. The Nottingham Health Profile (NHP) questionnaire was used as a comparator to test for convergent validity. Results The translation captured the same concepts as the English questionnaire and produced a comprehensive instrument in a Brazilian-Portuguese version expressing common, natural language. The psychometric evaluation involved 102 patients (48.8 ± 14.5 years, 80,4% female]. Cronbach’s alpha coefficients were above 0.9 on all three CAMPHOR scales. There was excellent test-retest reliability (coefficients above 0.85 on all scales). CAMPHOR Symptoms scale and Activities scale correlated highly with Physical Mobility section and CAMPHOR QoL scale was strongly associated with the Emotional Reactions and Social Isolation sections of NHP. There was a significant association between gender and perceived general health (p Conclusions The present CAMPHOR version demonstrated good psychometric properties and provides a reliable instrument for assessing HRQL and QoL in Brazilian PH patients, addressing patients’ perspective of their illness in a comprehensive way.

We introduce an integral transform that maps differential equations and special functions of standard continuous calculus onto finite difference equations and deformed special functions of mimetic discrete calculus, or h-calculus. We show that our procedure leads to insightful reformulations of several problems in mathematics and physics where discrete equations play a significant role, such as in solving finite difference equations, in applying discrete versions of integral transforms, such as the h-Laplace transform, in solving master equations of stochastic physics, in developing a discrete version of H theory of multiscale complex hierarchical phenomena and in finding lattice Green’s functions for describing quantum charge transport through phase coherent systems. We believe that our integral transform technique, or mimetic map, will help systematize the connections through analogy between discrete calculus and standard continuous calculus.

The objective of this work was to evaluate the application of kinetin associated with nitrogen in coverage on the agronomic characteristics and soybean yield. In the 2016/2017 harvest, a 6x2 factorial scheme was used, six doses of kinetin (0; 0.30; 0.60; 0.90; 1.20; 1.50 g ha−1) and two doses of N (20 and 40 kg ha−1) and in the 2017/2018 harvest, factorial scheme 5x2 was used, five doses of kinetin (0; 0.25; 0.75; 1.00; 1.25 g ha−1) and two doses of N (20 and 40 kg ha−1). Agronomic plant height characteristics, first pod insertion height, number of grains per plant, number of pods per plant, number of grains per pod, number of grains per pod, hundred-grain mass and grain yield were evaluated. The use of N alone and associated with kinetin increased the number of pods and grains in the 2016/2017 harvest. In the 2017/2018 crop, kinetin caused a reduction of 8.9% at plant height and N caused an increase in plant height and first pod insertion and reduced the number of pods and grains per plant, grains per pods and productivity. Made available in DSpace on 2021-01-23T09:10:16Z (GMT). No. of bitstreams: 1 asrhets-2020-2.pdf: 747573 bytes, checksum: bad7e2379b5f9ed669cd3930b049459b (MD5) Previous issue date: 2020

De-identified patient-reported-outcomes raw data coming from NHP questionnaires.

Background Integrating cardiopulmonary resuscitation (CPR) training in secondary schools will increase the number of potential CPR providers. However, currently too few certified instructors are available for this purpose. Training medical students and physical education student teachers to become CPR instructors could decrease this shortage. Aim Examine whether medical students and physical education student teachers can provide CPR training for secondary school pupils as well as (i. e., non-inferior to) registered nurses. Methods A total of 144 secondary school pupils were randomly assigned to CPR training by a registered nurse (n = 12), a medical student (n = 17) or a physical education student teacher (n = 15). CPR performance was assessed after training and after eight weeks in a simulated cardiac arrest scenario on a resuscitation manikin, using manikin software and video recordings. Results No significant differences were found between the groups on the overall Cardiff Test scores and the correctness of the CPR techniques during the post-training and retention test. All pupils showed sufficient CPR competence, even after eight weeks. Conclusion Training by medical students or physical education student teachers is non-inferior to training by a registered nurse, suggesting that school teachers, student teachers and medical students can be recruited for CPR training in secondary schools.

We present a combined fit of a simple astrophysical model of UHECR sources to both the energy spectrum and mass composition data measured by the Pierre Auger Observatory. The fit has been performed for energies above 5 EeV, i.e. the region of the all-particle spectrum above the so-called "ankle"' feature. The astrophysical model we adopted consists of identical sources uniformly distributed in a comoving volume, where nuclei are accelerated with a rigidity-dependent mechanism. The fit results suggest sources characterized by relatively low maximum injection energies and hard spectral indices. The impact of various systematic uncertainties on the above result is discussed., 0, SCOPUS: cp.p, info:eu-repo/semantics/published

The Dutch Embryos Act (2000) contains a temporary ban on the creation of embryos for research, meaning that, at present, only research using "spare" IVF embryos is allowed. Recently, the government has announced a plan to lift this ban. This is in line with the original intention of the Act, which already contains conditions for research with specially created embryos that will come into force after the lifting of the ban, including the restriction that the research must be expected to yield new insights in the domains of infertility, assisted reproduction, hereditary or congenital disorders, or transplantation medicine. The government plans announced allow research only in the first three of these domains, adding the further criterion that the research must be 'directly relevant for clinical application'. According to the government, the reason for these additional restrictions was the need to protect 'human dignity'. The authors of this paper are not convinced.

Prenatal screening for Down syndrome has to date focused on facilitating the informed choice to continue or not with a pregnancy. The non-invasive prenatal test (NIPT) for Down syndrome does potentially offer the option to apply foetal neurocognitive therapy for Down syndrome (FTDS). Current research in animal models looks promising and therefore a proactive ethical reflection in relation to clinical trials is urgently needed. This discussion includes an exploration of the ethical aspects of FTDS. There seem to be no convincing a priori objections on the basis of the social model of disability. Arguments in terms of (respect for) autonomy, wellbeing and justice seem to in principle support such therapy. Still, both the conditions for sound clinical trials and the implications of possible effective therapy for current prenatal screening need further scrutiny.

Objective To study whether field performance tests can make a valid distinction between non-functionally overreaching (NFO) athletes and control athletes.Design Monthly field performance tests were used to determine a performance decrement (PD) throughout a season. Athletes with a minimum of 1 month PD were compared with control athletes without a PD on mood characteristics and resting levels of stress hormones.Setting Sporting field and sports medical laboratory.Participants 129 young elite athletes, 77 soccer players and 52 middle-long distance runners were followed prospectively during the 2006-2007 season. Fifteen of them were invited to the laboratory. Eight athletes showed a performance decrease lasting longer than 1 month, and seven athletes without a performance decrease acted as their controls.Main outcome measures Performance changes over time were measured using field tests. Profile of Mood States and resting levels of adrenocorticotrophic hormone (ACTH) and cortisol in blood were measured in the laboratory.Results PD athletes showed several symptoms typical of the non-functional state of overreaching (OR). The PD group scored higher on depression and anger than controls. They also showed a specific pattern of correlations between negative mood subscales (tension, fatigue and depression), which was absent in controls. ACTH levels at rest were similar, but lower cortisol levels in PD athletes pointed at a blunted cortisol response. Cortisol levels were decoupled from ACTH levels only in PD athletes.Conclusions Implementing performance-related criteria in field tests can help coaches and sports physicians to distinguish NFO athletes from athletes with balanced workload and recovery.

Sri Lanka's ethnic war that lasted over 25 years produced a militarized country, political fragmentation, deep ethnic division, poor governance, and a weak economy. Reconciliation, peace building, and transformation of the politics and economy are essential for Sri Lanka to recover. However, prospects are not as good as they could be. Its major Western trading partners and donors are unhappy with the country's human rights record. The government is further strengthening the military. The current leadership is using the undemocratic institutions and practices of governance that the war created. Two-thirds of the people who have known little other than war, poor governance, and patronage politics may take a long time to realize their responsibility to pressure the rulers to mend their ways.

One of the hallmark symptoms of patients with chronic heart failure (CHF) is exercise intolerance. Therefore, exercise testing has become an important tool for the evaluation and monitoring of heart failure. Whereas the maximal aerobic capacity (peak VO(2)) is a reliable indicator of the severity and prognosis of heart failure, submaximal exercise parameters may be more closely related to the ability to perform daily activities. As such, oxygen (O(2)) uptake kinetics, describing the rate change of O(2) uptake during onset or recovery of submaximal constant-load exercise (O(2) onset and recovery kinetics, respectively), have been shown to be useful parameters for objectively evaluating the functional capacity of CHF patients. However, their evaluation in this population is not a routine part of daily clinical practice. Possible reasons for this include a lack of standardisation of the assessment methodology and a limited number of studies evaluating the clinical use of O(2) uptake kinetics in CHF patients. In addition, the pathophysiological mechanisms underlying the delay in O(2) uptake kinetics in these patients are not completely understood. This review discusses the current literature on the clinical potency and physiological determinants of O(2) uptake kinetics in CHF patients and provides directions for future research. (Neth Heart J 2009;17:238-44.Neth Heart J 2009;17:238-44.).

Background: A persistent sciatic artery (PSA) is a rare vascular anomaly with an estimated incidence of 0.03-0.06%. During early embryonic development, the sciatic artery usually disappears when the superficial femoral. artery has developed property. This study aimed to assess the clinical presentation and outcome of a PSA. Method: A systematic review of all cases of PSA published between 1964 and 2007 was performed. Results: In this review, 159 PSAs were described in 122 patients. The mean age at which the PSA was discovered was 57 years, and the incidence was equally distributed with regards to gender. The majority of PSAs was unilateral (70%) and of the complete type (79%). Ninety-one patients (80%) presented with symptoms including intermittent ctaudication, ischaemia, a pulsating mass or neurological symptoms. An aneurysm was found in 48%, a stenosis in 7%, an occlusion of the PSA in 9% and an occlusion of an artery distal to the PSA in 6% of the subjects. The treatment depended on the symptoms and classification of the PSA. In nine cases (8%), an amputation was required eventually. Conclusion: The PSA is a rare anomaly with a high incidence of complications including aneurysm formation and ischaemia that may Lead to amputation. Strategies for follow-up could not be deduced from the available literature. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

SYNOPSIS Notes dealing with 12 species of Teframesa, two species of Bruchophagus and 12 of Eurytoma include new synonymy and designation of lectotypes. Eurytoma fumipennis, E. squamea and E. apicalis are redescribed, and the diagnostic characters of some other species are re-assessed. Attention is drawn to the value of the characters of theclypeus as an aid to classification in Eurytoma.

SYNOPSIS An account is given of three species of Eupelmus new to Britain, and notes are given on a number of other Eupelmidae already recorded from Britain. The diagnostic characters of Calosota vernalis and C. aestivalis are redescribed, and a key is given to the females of the British species of Calosota. Some lectotypes are validated.

SYNOPSIS An account is given of one species of Syntomaspis and five species of Torymus new to Britain, and notes are given on a number of other Torymidae already recorded from Britain. A new specific character found in the genera Torymus and Callimomus is discussed.

The practice of prenatal screening is undergoing important changes as a result of the introduction of genomic testing technologies at different stages of the screening trajectory. It is expected that eventually it will become possible to routinely obtain a comprehensive 'genome scan' of all fetuses. Although this will still take several years, there are clear continuities between present developments and this future scenario. As this review shows, behind the still limited scope of screening for common aneuploidies, a rapid widening of the range of conditions tested for is already taking shape at the invasive testing stage. But the continuities are not just technical; they are also ethical. If screening for Down's syndrome is a matter of providing autonomous reproductive choice, then why would providing the choice to have a full fetal genome scan be something entirely different? There is a clear need for a sustainable normative framework that will have to answer three challenges: the indeterminateness of the autonomy paradigm, the need to acknowledge the future child as an interested stakeholder, and the prospect of broad-scope genomic prenatal screening with a double purpose: autonomy and prevention.

Purpose: The development of complex radiation treatment schemes emphasizes the need for advanced QA analysis methods to ensure patient safety. One such tool is the Delta4 DVH Anatomy software, where the patient dose is reconstructed from phantom measurements. Deviations in the measured dose are transferred to the patient anatomy and their clinical impact is evaluated in situ. Results from the original algorithm revealed weaknesses that may introduce artefacts in the reconstructed dose. These can lead to false negatives or obscure the effects of minor dose deviations from delivery failures. Here, we will present results from a new patient dose reconstruction algorithm. Methods: The main steps of the new algorithm are: (1) the dose delivered to a phantom is measured in a number of detector positions. (2) The measured dose is compared to an internally calculated dose distribution evaluated in said positions. The so-obtained dose difference is (3) used to calculate an energy fluence difference. This entity is (4) used as input to a patient dose correction calculation routine. Finally, the patient dose is reconstructed by adding said patient dose correction to the planned patient dose. The internal dose calculation in step (2) and (4) is based on the Pencil Beam algorithm. Results: The new patient dose reconstruction algorithm have been tested on a number of patients and the standard metrics dose deviation (DDev), distance-to-agreement (DTA) and Gamma index are improved when compared to the original algorithm. In a certain case the Gamma index (3%/3mm) increases from 72.9% to 96.6%. Conclusion: The patient dose reconstruction algorithm is improved. This leads to a reduction in non-physical artefacts in the reconstructed patient dose. As a consequence, the possibility to detect deviations in the dose that is delivered to the patient is improved. An increase in Gamma index for the PTV can be seen. The corresponding author is an employee of ScandiDos

2,2'-Bipyridine (bpy) and a series of dimethyl-2,2'-bipyridines were synthesized from 2-bromopyridine and 2-bromomethylpyridines, respectively, using an electrochemical process catalyzed by nickel complexes. The method is simple and efficient, with isolated yields between 58 and 98% according to the structure. We first studied the influence of the presence and the position of the methyl group on the yield, using N,N-dimethylformamide (DMF) or acetonitrile (AN) as the solvent, NiBr(2)bpy as the catalyst, and Zn as the sacrificial anode, in an undivided cell and at ambient temperature. On the basis of a better understanding of the reaction mechanism based on electroanalytical studies, we could improve the dimerization both by substituting the catalyst ligand (bpy) by the reagent itself, i.e., 2-bromomethylpyridine or 2-bromopyridine, and by using Fe instead of Zn as the sacrificial anode.