Pretrial Quality Assurance for Hypofractionated Salvage Radiation Therapy After Prostatectomy in the Multi-Institutional PERYTON-trial

Purpose: The PERYTON trial is a multicenter randomized controlled trial that will investigate whether the treatment outcome of salvage external beam radiation therapy (sEBRT) will be improved with hypofractionated radiation therapy. A pretrial quality assurance (QA) program was undertaken to ensure protocol compliance within the PERYTON trial and to assess variation in sEBRT treatment protocols between the participating centers. Methods and Materials: Completion of the QA program was mandatory for each participating center (N = 8) to start patient inclusion. The pretrial QA program included (1) a questionnaire on the center-specific sEBRT protocol, (2) a delineation exercise of the clinical target volume (CTV) and organs at risk, and (3) a treatment planning exercise. All contours were analyzed using the pairwise dice similarity coefficient (DSC) and the 50th and 95th percentile Hausdorff distance (HD50 and HD95, respectively). The submitted treatment plans were reviewed for protocol compliance. Results: The results of the questionnaire showed that high-quality, state-of-the-art radiation therapy techniques were used in the participating centers and identified variations of the sEBRT protocols used concerning the position verification and preparation techniques. The submitted CTVs showed significant variation, with a range in volume of 29 cm3 to 167 cm3, a mean pairwise DSC of 0.52, and a mean HD50 and HD95 of 2.3 mm and 24.4 mm, respectively. Only in 1 center the treatment plan required adaptation before meeting all constraints of the PERYTON protocol. Conclusions: The pretrial QA of the PERYTON trial demonstrated that high-quality, but variable, radiation techniques were used in the 8 participating centers. The treatment planning exercise confirmed that the dose constraints of the PERYTON protocol were feasible for all participating centers. The observed variation in CTV delineation led to agreement on a new (image-based) delineation guideline to be used by all participating centers within the PERYTON trial.</p

Unpacking the European Commission's fiscal policy response to crisis:mapping and explaining economic ideas in the European Semester 2011–2022

In this paper, we examine how and why the European Commission's ideas on fiscal policy have changed over the course of the European Semester. Empirically, we rely on a semi-supervised scaling approach to identify economic ideas as they appear in Semester documents from the aftermath of the financial crisis onwards (2011-2022). Our findings demonstrate a gradual shift in ideas from an ordoliberal to a Keynesian direction, especially during the overlapping Von der Leyen and Covid-19 crisis years. We identify substantial country-specific differences throughout 2011–2022, with some countries receiving exclusively Keynesian recommendations, and others distinctively ordoliberal ones. These patterns can be explained in part by economic conditions in those member states but not by the public's trust in the EU. These results underscore the reactive nature of the Commission's economic ideology; crises, as well as member states’ economic conditions, shape the direction of its fiscal policy recommendations

Role of non-invasive objective markers for the rehabilitative diagnosis of central sensitization in patients with fibromyalgia:A systematic review

BACKGROUND: Central sensitization cannot be demonstrated directly in humans. Therefore, studies used different proxy markers (signs, symptoms and tools) to identify factors assumed to relate to central sensitization in humans, that is, Human Assumed Central Sensitization (HACS). The aims of this systematic review were to identify non-invasive objective markers of HACS and the instruments to assess these markers in patients with fibromyalgia (FM).METHODS: A systematic review was conducted with the following inclusion criteria: (1) adults, (2) diagnosed with FM, and (3) markers and instruments for HACS had to be non-invasive. Data were subsequently extracted, and studies were assessed for risk of bias using the quality assessment tools developed by the National Institute of Health.RESULTS: 78 studies (n= 5234 participants) were included and the findings were categorized in markers identified to assess peripheral and central manifestations of HACS. The identified markers for peripheral manifestations of HACS, with at least moderate evidence, were pain after-sensation decline rates, mechanical pain thresholds, pressure pain threshold, sound 'pressure' pain threshold, cutaneous silent period, slowly repeated evoked pain sensitization and nociceptive flexion reflex threshold. The identified markers for central manifestations of HACS were efficacy of conditioned pain modulation with pressure pain conditioning and brain perfusion analysis. Instruments to assess these markers are: pin-prick stimulators, cuff-algometry, repetitive pressure stimulation using a pressure algometer, sound, electrodes and neuroimaging techniques.CONCLUSIONS: This review provides an overview of non-invasive markers and instruments for the assessment of HACS in patients with FM. Implementing these findings into clinical settings may help to identify HACS in patients with FM.</p

Day-to-day affect fluctuations in adults with childhood trauma history:a two-week ecological momentary assessment study

BACKGROUND: Childhood trauma (CT) may increase vulnerability to psychopathology through affective dysregulation (greater variability, autocorrelation, and instability of emotional symptoms). However, CT associations with dynamic affect fluctuations while considering differences in mean affect levels across CT status have been understudied.METHODS: 346 adults (age = 49.25 ± 12.55, 67.0% female) from the Netherlands Study of Depression and Anxiety participated in ecological momentary assessment. Positive and negative affect (PA, NA) were measured five times per day for two weeks by electronic diaries. Retrospectively-reported CT included emotional neglect and emotional/physical/sexual abuse. Linear regressions determined associations between CT and affect fluctuations, controlling for age, sex, education, and mean affect levels.RESULTS: Compared to those without CT, individuals with CT reported significantly lower mean PA levels (Cohen's d = -0.620) and higher mean NA levels ( d = 0.556) throughout the two weeks. CT was linked to significantly greater PA variability ( d = 0.336), NA variability ( d = 0.353), and NA autocorrelation ( d = 0.308), with strongest effects for individuals reporting higher CT scores. However, these effects were entirely explained by differences in mean affect levels between the CT groups. Findings suggested consistency of results in adults with and without lifetime depressive/anxiety disorders and across CT types, with sexual abuse showing the smallest effects. CONCLUSIONS: Individuals with CT show greater affective dysregulation during the two-week monitoring of emotional symptoms, likely due to their consistently lower PA and higher NA levels. It is essential to consider mean affect level when interpreting the impact of CT on affect dynamics.</p

The keys of pressing to gain the ball:Characteristics of defensive pressure in elite soccer using tracking data

Recently, the availability of big amounts of data enables analysts to dive deeper into the constraints of performance in various team sports. While offensive analyses in football have been extensively conducted, the evaluation of defensive performance is underrepresented in this sport. Hence, the aim of this study was to analyze successful defensive playing phases by investigating the space and time characteristics of defensive pressure. Therefore, tracking and event data of 153 games of the German Bundesliga (second half of 2020/21 season) were assessed. Defensive pressure was measured in the last 10 seconds of a defensive playing sequence (time characteristic) and it was distinguished between pressure on the ball-carrier, pressure on the group (5 attackers closest to the ball), and pressure on the whole team (space characteristic). A linear mixed model was applied to evaluate the effect of success of a defensive play (ball gain), space characteristic, and time characteristic on defensive pressure. Defensive pressure is higher in successful defensive plays (14.47 ± 16.82[%]) compared to unsuccessful defensive plays (12.87 ± 15.31[%]). The characteristics show that defensive pressure is higher in areas closer to the ball (space characteristic) and the closer the measurement is to the end of a defensive play (time characteristic), which is especially true for successful defensive plays. Defensive pressure is a valuable key performance indicator for defensive play. Further, this study shows that there is an association between the pressing of the ball-carrier and areas close to the ball with the success of defensive play.</p

Toward consensus on pain-related content in the pre-registration, undergraduate physical therapy curriculum:a Delphi-study

Background: Access to pain education for healthcare professionals is an International Association for the Study of Pain's key recommendation to improve pain care. The content of preregistration and undergraduate physical therapy pain curricula, however, is highly variable. Objective: This study aimed to develop a list, by consensus, of essential pain-related topics for the undergraduate physical therapy curriculum. Methods: A modified Delphi study was conducted in four rounds, including a Delphi Panel (N = 22) consisting of in pain experienced lecturers of preregistration undergraduate physical therapy of Universities of Applied Sciences in the Netherlands, and five Validation Panels. Round 1: topics were provided by the Delphi Panel, postgraduate pain educators, and a literature search. Rounds 2–4: the Delphi Panel rated the topics and commented. All topics were analyzed in terms of importance and degree of consensus. Validation Panels rated the outcome of Round 2. Results: The Delphi Panel rated 257, 146, and 90 topics in Rounds 2, 3, and 4, respectively. This resulted in 71 topics judged as “not important,” 97 as “important,” and 89 as “highly important.” In total, 63 topics were rated as “highly important” by the Delphi Panel and Validation Panels. Conclusion: A list was developed and can serve as a foundation for the development of comprehensive physical therapy pain curricula.</p

Understanding sustainable professional learning communities by considering school leaders’ interpretations and educational beliefs

The way in which school leaders implement professional learning communities (PLCs) is important for realizing sustainable school improvement. The assumption is that school leaders act based on their interpretation of the PLC, which is based on their underlying educational beliefs. In this study, we explored these latter aspects by interviewing six formal and informal school leaders, discussing the sustainability of PLCs in two secondary schools that had each worked with PLCs for seven years. The results of this in-depth qualitative study show that the schools differed in the degree of sustainability they achieved: one still used the PLC as intended; the other now omitted one step of the original format. This can be explained by the leaders’ interpretations of the PLC and their educational beliefs. Furthermore, we found that student- and col-laboration-oriented beliefs are critical for continuing the work of a PLC. Finally, we found that the organizational context mediates-whether leaders act upon their beliefs. Tensions between leaders’ beliefs and the organizational context, such as fear of colleagues’ resistance, appeared to influence their choice to act or not concern-ing specific aspects of the PLC. These findings can give school leaders insights into conditions for sustainable school improvement with PLCs. <br/

The “War on Terror” and Public Diplomacy during the Cold War:Israeli–Turkish Relations and the 1980 Military Coup

What influence does the digital diplomacy of the post 9/11 world have on our understanding of counter-terrorism (CT) diplomacy during the Cold War? This article explores this question and the intersection between intelligence, counterterrorism diplomacy and the digital transformation long overlooked by scholars of Israeli–Turkish relations, Cold War history and terrorism studies. Diplomacy in crisis situations usually operates in an uncertain reality triggered by conflict. Turkey’s domestic crises, specifically its energy crisis between 1978 and 1980, served to shift the country’s foreign policy toward the more anti-Israeli stance of the Arab nations and their demands that Turkey boycott Israel in return for supplying Turkey’s energy needs. This came in the context of a regional wave of contentious politics in the Middle East after the 1979 Iranian revolution, when Israel had just lost three decades of massive investment in Iran under the Shah. I argue that knowing the Turkish military junta’s primary goals centered on the fight against the far left and right political violence at home and on Armenian terror attacks against Turkish diplomats abroad, Israeli diplomats employed a very selective CT policy focusing on the cooperation between Armenian Secret Army for the Liberation of Armenia and the Palestine Liberation Organization. Public diplomacy was key to conveying this message, and attempts to plant information about the Armenian-Palestinian cooperation in Turkish news outlets and national television were made. Israel’s goal was to influence Turkey’s public emotions and convey to Turkey’s military junta that Jerusalem was a true ally, working to confront the mutual regional threat of Armenian-Palestinian terrorists arising from Lebanese training camps. This case study highlights the paradox that Ministries of Foreign Affairs and diplomats enjoyed an unparalleled monopoly of power during the Cold War over the use of means of public diplomacy, while at the time having very limited capacity, and a frequent need for third party mediators to engage with foreign public audiences. It is thus unlikely that the conveyed messages would have been as visible and disseminated as easily as they could be in the post 9/11 via means of digital diplomacy.</p

The Muslim Brotherhood and women’s issues under Sadat:dogmas and discussions

This paper examines why the MB was cautious in its revision of views on women under Anwar Sadat when it was, at the same time, changing the way it dealt with politics and the issue of revolutionary violence, by looking at the movement’s view on women as expressed in its own writings. I argue that the MB’s view on women was in line with the Islamic revival Egypt experienced. Given the nature of Egyptian society under Sadat, in which women still mainly played central roles in the domestic setting, reconsidering their traditional position was not viewed by the movement and many of the Egyptians it reached out to as something that needed change, contrary to the country’s administrative situation. Additionally, women’s issues were used by the MB as a tool to showcase its piety. This was instrumental in its search for political and religious authority, which the movement needed in order to expand its membership, lead the fragmented Islamic movement, deal with its own divided rank-and-file, and challenge the Sadat administration.<br/

Treatment of clinically uninfected diabetic foot ulcers, with and without antibiotics

Objective: Current guidelines do not recommend the use of antibiotics to treat clinically uninfected ulcers. However, physicians continue to prescribe antibiotics for clinically uninfected ulcers with the rationale ‘better to be safe than sorry’. Yet, antibiotic resistance is increasing, side-effects are common and treatment costs are rising. Evidence is needed to identify whether antibiotic treatment for clinically uninfected ulcers can be justified or we should stop prescribing them. The aim of this study was to evaluate whether antibiotic treatment in cases of clinically uninfected ulcers improved ulcer healing compared to treatment without antibiotics. Method: Consecutive patients treated in the outpatient clinic for clinically uninfected diabetic foot ulcer both in 2015 and in 2017 were retrospectively analysed. Primary outcome was ulcer healing at one year. Secondary outcomes were limb salvage, freedom from any amputation, amputation-free survival (AFS) and survival. Results: A total of 102 ulcers of 91 patients were included for final analyses. The non-antibiotics and antibiotics groups both consisted of 51 ulcers. Ulcer healing at one year was 77.3% in the non-antibiotics group and 74.7% in the antibiotics group (p=0.158). No difference was found for limb salvage (93.8% versus 95.9%, respectively; p=0.661), freedom from any amputation (85.6% versus 85.6%, respectively; p=1.000), AFS (85.4% versus 79.1%, respectively; p=0.460) or survival (89.6% versus 83.7%, respectively; p=0.426). Conclusion: In this study, no benefits of antibiotic treatment over non-antibiotic treatment for clinically uninfected ulcers were identified. The findings of this study emphasise the recommendation of current guidelines to not treat clinically uninfected ulcer with antibiotics.</p