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How teachers attend to and interpret positive relational interactions shapes how they enact instructional practices for equity. We draw on frameworks from equitable mathemat- ics instruction, relational interactions, and teacher noticing to conceptualize mathematics teachers’ relational noticing. Using noticing interview and classroom observation data from a research collaborative between secondary mathematics teachers and university-based teacher educators, we document the range and diversity of ten teachers’ relational noticing. We use this analysis to examine how teachers’ relational noticing supports enacting equi- table instructional practices. Our findings indicate five themes of teachers’ relational notic- ing that are informed by their personal histories, understanding of dominant narratives of mathematics education, and their local sociopolitical school context. Additionally, teachers enacted a range of practices for creating positive relational interactions, with attending to student thinking being the most enacted practice. Our findings suggest that mathematics teachers’ relational noticing can support the three axes of equitable instruction.

Beginning teachers are challenged to make concrete the identities they envision for themselves in their practice. We examine how a particular context, the noticing interview, supported a novice teacher's identity work through disciplined awareness to cultivate the inner witness. In a noticing interview, teachers view and discuss video segments from a classroom observation as a way to capture in-the-moment attention and sensemaking. Using the case of a beginning teacher, we found that creating accounts of instructional practice and accounts for instructional decisions helped her connect the dots between her vision of teaching, her personal and social identities, and her pedagogical commitments. These findings have implications for whether and how the noticing interview can become a generative context for teachers developing insights about themselves as noticers in practice and their emerging professional identities.

Background: Recently it has been suggested that coronary microvascular dysfunction (CMD) may explain the high false-positive rate of exercise electrocardiographic stress testing (EST). However, patients with angina but non-obstructive coronary artery disease (ANOCA) present with a broader spectrum of coronary vasomotor dysfunction (CVDys), namely coronary artery spasm (CAS), CMD or a combination of both. We aim to investigate the diagnostic value of EST for the entire CVDys spectrum. Methods: We included patients who underwent coronary function testing (CFT) in the Radboud University Medical Center. For each patient we requested the most recent EST report. ESTs were denoted as positive for ischemia if clinically significant ST-segment depression was detected. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals for the diagnosis of CVDys and its endotypes. Results: Of the 105 included patients (87 % women, mean age 57 (±8) years), 22 (21 %) had ischemia during EST. CVDys was diagnosed in 94 patients (90 %), of whom 58 patients had an isolated endotype (CAS: n = 51, CMD: n = 7) and 36 patients had CAS and CMD. Ischemia during EST yielded a high specificity and PPV for CVDys (specificity: 100 % (71.5–100 %), PPV: 100 % (84.6–100 %)), which remained reasonably similar for CAS (specificity: 94.4 % (72.7–99.9 %), PPV: 95.5 % (77.2–99.9 %)), but was lower for CMD (specificity: 85.5 % (74.2–93.1 %), PPV: 59.1 % (36.4–79.3 %)). Conclusions: Ischemia during EST is highly specific for CVDys in general and can be an indicator for CAS and to a lesser extent for CMD in patients with ANOCA.

Background and purpose: For medial knee osteoarthritis (OA), operative and nonoperative treatment options are available. Two widely applied unloading therapies are a valgus unloader brace and a high tibial osteotomy (HTO). We aimed to compare the effects of a valgus unloader knee brace with an HTO on knee pain after 1 year in patients with symptomatic medial knee OA. Methods: We recruited patients from 9 Dutch hospitals between August 2014 and February 2019 for an open-labeled multi-center randomized controlled trial (Dutch Trial Register NL4200). Patients aged 18 to 65 years with symptomatic medial compartmental knee OA were randomized to either a valgus unloader brace or an HTO. The primary outcome was the pain subscale of the Knee injury and Osteoarthritis Outcome score (KOOS) after 1 year. Patients were evaluated at 3, 6, 9, 12, and 24 months. Results: 51 patients were included in the study, of whom 23 were randomized to the unloader brace and 28 to the HTO. The HTO, compared with the unloader brace, showed a significant and clinically relevant difference at 12 months of follow-up in KOOS pain of –28 (95% confidence interval –43 to –13). Conclusion: We found that, on group level, an HTO is more effective in reducing knee pain than an unloader brace after 12 months.

Objective and rationale: Small studies have shown that the QT interval follows a circadian rhythm. This finding has never been confirmed in a large real-world hospital population and the clinical meaning of disrupted rhythmicity remains unknown. Methods: In this cohort study, all consecutive adult patients with at least one 12-lead ECG acquired between 1991 and 2021 were considered. Sinus rhythm ECGs without QRS conduction or ST-segment abnormalities obtained at the wards or outpatient clinic were included. The QT interval was corrected for age, sex and ventricular rate in a personalized manner. Subsequently, the added value of a 24-h sinusoid of time-of-day was evaluated. An individual 24-h QT interval amplitude was obtained from the model in a subset with patients that had at least 3 ECGs of which one during the night before their last ECG. The association of this individual QT interval with all-cause mortality was assessed using a left-truncated Cox regression model. Results: The baseline QT correction model was fitted using 237,555 ECGs of 100,644 patients. The personalized corrected QT interval had no relationship with ventricular rate (r = −0.008). Adding the 24-h sinusoidal to the baseline model resulted in a significantly better fit (p

Summary: Background: Female Lynch syndrome carriers have an increased risk of developing endometrial cancer. Regardless, research on endometrial carcinoma tumorigenesis is scarce and no uniform, evidence-based gynaecological management guidelines exist. We therefore described gynaecological surveillance and surgery outcomes in a nation-wide Lynch syndrome cohort. Methods: For this retrospective cohort study, female Lynch syndrome carriers, prospectively registered in the Dutch Lynch syndrome database (StOET), were included up to February 28th 2022. Carriers were linked to the Dutch national pathology (PALGA) database. The number of carriers with/without gynaecological surveillance, number of index carriers with endometrial carcinoma before Lynch syndrome diagnosis were assessed, as well as uptake of risk-reducing surgery and characteristics of endometrial carcinomas including the requisite for adjuvant therapy according to current guidelines. Overall survival after endometrial carcinoma diagnosis was analyzed using Kaplan Meier time to event analyses, cumulative incidence was calculated after adjusting for competing risks (death and prophylactic hysterectomy). Findings: In total, 1046 registered female Lynch syndrome carriers were eligible for surveillance, of whom 313 (30.0%) did not have surveillance and 21.4% (n = 224 of 1046) opted for prophylactic hysterectomy. In carriers with surveillance, more cases of endometrial carcinoma and hyperplasia were found than in those without (37 endometrial carcinomas (7.3%) and 28 hyperplasias (5.5%) in 506 carriers with surveillance versus 14 (2.6%) and 4 (0.7%) in 540 carriers without surveillance, respectively); carriers with surveillance were generally younger than those without (median 56 years [IQR 48–65] versus median 65 years [IQR 49–75] at database assembly, respectively; p

Abnormal airway dilatation, termed traction bronchiectasis, is a typical feature of idiopathic pulmonary fibrosis (IPF). Volumetric computed tomography (CT) imaging captures the loss of normal airway tapering in IPF. We postulated that automated quantification of airway abnormalities could provide estimates of IPF disease extent and severity. We propose AirQuant, an automated computational pipeline that takes an airway segmentation and CT image as input and systematically parcellates the airway tree into its lobes and generational branches, deriving airway structural measures from chest CT. Importantly, AirQuant prevents the occurrence of spurious airway branches by thick wave propagation and removes loops in the airway-tree by graph search, overcoming limitations of existing airway skeletonisation algorithms. Tapering between airway segments (intertapering) and airway tortuosity computed by AirQuant were compared between 14 healthy participants and 14 IPF patients. Airway intertapering was significantly reduced in IPF patients, and airway tortuosity was significantly increased when compared to healthy controls. Differences were most marked in the lower lobes, conforming to the typical distribution of IPF-related damage. AirQuant is an open-source pipeline that avoids limitations of existing airway quantification algorithms and has clinical interpretability. Automated airway measurements may have potential as novel imaging biomarkers of IPF severity and disease extent.

Objective: Analyzing population trends of bone shape variation can provide valuable insights into growth processes. This review aims to overview state-of-the-art spatiotemporal statistical shape modeling techniques, emphasizing their application to 3D skeletal structures during healthy growth. Methods: We searched PubMed and Scopus for articles on statistical shape modeling using a pediatric spatiotemporal dataset of 3D healthy bone models. Dataset characteristics and details on the shape models' development, analyses, and potential clinical use were extracted. Results: Fourteen studies were found eligible, modeling one or multiple lower limb bones, the mandible, the skull, and vertebrae. The majority applied Principal Component Analysis on point distribution models to create a statistical shape model. Shape variation was analyzed based on shape modes, representing a specific shape change as a part of the overall variance. Unscaled models resulted in a more compact statistical shape model than scaled models. The latter represented more subtle shape variations due to the absence of size differences between the bone models. Four studies reported a significant correlation between the first shape mode and age, indicating a relationship between that type of shape variation and growth. Three studies reconstructed 3D models using prediction features of statistical shape modeling. Measuring difference between predicted and actual anatomy resulted in Root Mean Squared Errors below 3 mm. Conclusion: Spatiotemporal statistical shape modeling provides insight into modes of shape variation during growth. Such a model can be used to find predictive factors, like age or sex, and deploy these characteristics to predict someone's bone geometry.