Risk of new HIV diagnosis by intersecting migration, socioeconomic, and mental health vulnerabilities in the Netherlands:a nationwide analysis of the ATHENA cohort and Statistics Netherlands registry data

Background: To further reduce new HIV diagnoses in the Netherlands, individual and structural barriers hindering prevention must be addressed. We aimed to estimate the disproportional burden of new HIV diagnoses and explore how intersecting socio-demographic, socio-economic, and health-related factors jointly influence the risk of a new HIV diagnosis. Methods: We combined data from the ATHENA cohort, an ongoing nationwide HIV cohort, with registry data from Statistics Netherlands. We selected individuals with a new HIV diagnosis between 1 January 2012 and 31 December 2023 and matched them to individuals from the general population. We assessed determinants of a new HIV diagnosis using a multivariable generalized linear model. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify the joint and individual contribution of intersecting variables. Findings: 6055 men and 1020 women were newly diagnosed with HIV. Having a migration background and a low to middle income or income below the poverty line was associated with a higher risk of a new HIV diagnosis for both men (low to middle: adjusted odd ratio (aOR) = 1.24, 95% confidence interval (CI) = 1.17–1.31; below the poverty line: aOR = 1.75, 95% CI = 1.62–1.89) and women (low to middle: aOR = 2.49, 95% CI = 2.05–3.01; below the poverty line: aOR = 4.71, 95% CI = 3.80–5.83). Use of mental health care (aOR = 1.14, 95% CI = 1.01–1.27) or antidepressants (aOR = 1.66, 95% CI = 1.50–1.84) also increased the risk among men; while receiving social welfare (aOR = 1.39, 95% CI = 1.15–1.67) and use of antipsychotic medication (aOR = 1.66, 95% CI = 1.21–2.28) increased the risk among women. Of all intersections identified in MAIHDA, men with a first-generation migration background, income below the poverty line, and who used antidepressants had the highest predicted probability of an HIV diagnosis (0.036%, 95% confidence interval (CI) = 0.025–0.052). Women with a first-generation background, income below the poverty line, who received social welfare, and who used antipsychotic medication had the highest predicted risk (0.019%, 95% CI = 0.011–0.035). Interpretation: A disproportionally higher burden of a new HIV diagnosis was observed for individuals with a migration background and economic and mental health vulnerabilities. HIV prevention and testing need to be reinforced in these groups. Funding: Dutch Ministry of Health, Welfare and Sport; TKI Health Holland

Fluoroless bedside implantation of the ProtekDuo cannula:clinical experience at a tertiary care center

The ProtekDuo dual-lumen cannula allows percutaneous support in right ventricular failure with or without gas exchange impairments. However, positioning of the device is resource demanding. The usual approach requires a fluoroscopy–equipped operating room, possibly limiting its wider and timely adoption. We report our initial experience with bedside, fluoroless ProtekDuo implantation under transesophageal echocardiography (TEE) guidance in a tertiary care national referral center. Eight critically ill patients underwent bedside ProtekDuo placement for right ventricular dysfunction or acute respiratory distress syndrome with right ventricular failure. All procedures were completed successfully without procedural complications. Our findings demonstrate that bedside, TEE-guided, fluoroless ProtekDuo cannulation is feasible and safe, potentially expanding access to advanced mechanical circulatory support.</p

Reduction of Hepatectomy Times in Dutch Organ Procurement Teams

Introduction Donor hepatectomy time exceeding 60 minutes is associated with poor liver transplant outcomes. A nationwide audit in 2018 showed that this critical time limit was frequently exceeded in Dutch procurement teams, particularly by those teams that were not affiliated with a liver transplant center. In order to reduce donor hepatectomy times, a nationwide intervention program was conducted, focusing on creating awareness and passing knowledge, mandatory training and introduction of simultaneous procurement of lung- and liver in all procedures. Methods In this retrospective study, we describe the effects of this intervention program on donor hepatectomy time in the Netherlands. A total of 1788 liver procurements performed between January 2013 and December 2022 were analyzed, divided in 873 before and 915 procedures after the intervention. Results Donor hepatectomy time decreased significantly from 55 [41-70] to 35 [28-43] minutes (p&lt;0.001), with virtually no more difference between all procurement teams. After introduction of simultaneous procurement, the difference in donor hepatectomy time between liver-only and liver-lung disappeared, (34 [28-42] vs. 35 [29-43] minutes, p=0.73). Importantly, the decrease in hepatectomy time did not result in an increase in severe surgical injury leading to graft loss (p=0.11). Discussion In conclusion, a significant and relevant reduction in hepatectomy time was achieved with this intervention program. We advocate a similar procurement intervention plan in any organ donation program independent of their context

Bone Health of Female Elite Cyclists Is Characterized by Impaired Cortical and Trabecular Microarchitecture

PURPOSE: Many elite road-race cyclists have low areal bone mineral density (aBMD) as previously shown by dual-energy X-ray absorptiometry (DXA). However, aBMD provides limited insight into bone quality. Therefore, this cross-sectional study aimed to assess volumetric BMD (vBMD), bone microarchitecture, and bone strength in elite road-race cyclists using high-resolution peripheral computed tomography (HR-pQCT), along with aBMD measured by DXA. METHODS: Twenty female elite (Tier 3/ 4) road-race cyclists (21 ± 2 y; BMI 20.8 ± 1.6 kg/m2) had DXA scans at the hip, lumbar spine, and total body to assess aBMD, and HR-pQCT scans at the distal radius and tibia to assess vBMD, bone microarchitecture, and failure load. Z-scores were calculated for all outcomes, with Z-scores &lt;-1 considered as low or impaired. The risk of low energy availability was assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q). RESULTS: Low aBMD was observed in 20%, 25%, 35%, and 10% of the participants at the hip, femoral neck, lumbar spine, and total body, respectively. Low total vBMD was present in 45% and 40% at the distal radius and tibia, respectively. With regard to bone microarchitecture, the tibial cortical area and tibial cortical thickness were low in 40% and 60% of the participants, respectively, and number and thickness of trabeculae at the tibia were low in 40% and 30% of the participants. The impairments were less pronounced at the distal radius. Failure load was low in 15% (radius) and 20% (tibia) of the participants. CONCLUSIONS: Along with low aBMD, a substantial proportion of female elite cyclists had impaired bone microarchitecture, mainly characterized by a low cortical area and thickness and low trabecular number and thickness, especially at the distal tibia

Nuances in the memory undermining effects of EMDR and imagery rescripting

We reviewed the evidence on the memory undermining ef(EMDR) and imagery rescripting. Both therapies appear to undermine memory quality by making memories less vivid and emotionally-negative. Also, while eye movements used in EMDR seem to increase spontaneous false memories, they do not increase the susceptibility to suggestion. Inconsistent findings have emerged on the effects of imagery rescripting on false memory generation. Furthermore, a substantial number of clinicians who use EMDR strongly believe in the notion of repressed memory and EMDR has been associated with the occurrence of recovered memories. The belief in repressed memory might encourage suggestive therapeutic techniques, thereby increasing the risk of false memory creation. Overall, nuance is required on potential memory undermining effects of EMDR and imagery rescripting

Signals of excellence or indifference? Dutch employers' perceptions of liberal arts bachelor's degrees

This paper investigates how Dutch employers perceive university college bachelor's degrees. These programmes were introduced as part of an excellence initiative in Dutch higher education, offering broad, interdisciplinary, and selective undergraduate degrees in liberal arts and sciences. By conducting semi-structured interviews with 20 recruiters based in the Netherlands, the study explores the graduate job selection process, examining the relative importance of different factors in employers' decisions and the signals sent by university college degrees to employers. The findings reveal that the signalling effect associated with university college degrees is either entirely absent or neutral. Dutch employers demonstrate limited familiarity with university colleges and tend to assign less significance to the bachelor's degree when it is accompanied by a master's degree in a relevant field. This underscores the challenge of integrating innovative educational models into the traditionally egalitarian research university segment of Dutch higher education

Stereotactic radiotherapy on Parkinson's disease induced tremors - a systematic review

Background: Parkinson's disease (PD) is a neurodegenerative disorder characterized by progressive disability due to bradykinesia, rigidity, and rest tremors. Especially in the treatment of tremors, pharmacological options often fall short. Invasive treatments such as deep brain stimulation are unsuitable in selected patients. Stereotactic radiotherapy (SRT) is a non-invasive alternative. However, implementation is hindered by inconsistent findings across studies. Materials and Methods: This study aims to evaluate the effect of SRT on tremors in PD patients. A PRISMA-guided systematic review identified 183 records. Six studies (n = 193 patients) met inclusion criteria. Outcomes were assessed after 12 months of SRT treatment. Results: All included studies used single-fraction SRT, prescribed doses ranged from 85-165 Gy, with 130-140 Gy being most frequently used. The ventral intermediate nucleus (VIM) was the most commonly targeted structure in three of the six studies. Across all studies tremor improvement was reported in 71 %-100 % of cases, with severity reduction of 38 %-67 % and tremor elimination in three studies varying from 0 % to 70 % of patients. Three studies noted medication reductions in 6 %-75 % of cases. Quality of life (QoL) and tremor recurrence were inconsistently reported: only one study reported no significant QoL improvement. Recurrence rates ranged from 3 %-24 %. Adverse events were present in 7 (7 %) patients. Conclusion: SRT is a promising non-invasive treatment for medically refractory PD tremor, with substantial tremor reduction and low toxicity. However, limitations such as the inconsistent reporting affect the strength of the findings. Future research should emphasize standardized reporting of treatment parameters and outcomes to strengthen evidence on SRT efficacy

A survey on skein modules via braids

In this paper we present recent results on the computation of skein modules of 3-manifolds using braids and appropriate knot algebras. Skein modules generalize knot polynomials in S^3 to knot polynomials in arbitrary 3-manifolds and they have become extremely essential algebraic tools in the study of 3-manifolds. In this paper we present the braid approach to the HOMFLYPT and the Kauffman bracket skein modules of the Solid Torus ST and the lens spaces L(p,1) and S^1\times S^2

ToF-SIMS spectra of typical substrates in both polarities: Si wafer, Au-coated glass, and ITO-coated glass

ToF-SIMS is a surface analysis technique, and as a result, many samples need to be spotted or mounted onto a suitable substrate. Different substrates can be used for ToF-SIMS analysis, and it is essential to properly assign the characteristic chemical signals from the substrate to distinguish them from the sample analyte ions. Here, the authors provide a reference database that provides ToF-SIMS spectra for three widely used substrates in positive and negative polarities. The six spectra were acquired using a 30 keV Bi3+ primary ion beam, with Ar gas cluster ion beam sputter cleaning of the surfaces before analysis.</p

Effects of pharmacist care on hospitalizations in heart failure across outpatient and inpatient settings:A systematic review and meta-analysis

Aims Heart failure (HF) is major cause of unplanned (re)hospitalizations, especially in high-risk patients such as those recently discharged or those with worsening HF. Hospital-affiliated or clinic-based pharmacists, though underutilized, may help reduce this burden. This systematic review and meta-analysis assessed their impact on all-cause and HF hospitalizations.Methods A systematic literature search using PUBMED and EMBASE and conducted according to PRISMA guidelines identified randomized controlled trials published up to November 2024. Eligible studies evaluated the effects of pharmacy interventions on hospitalizations and mortality among patients with HF. Studies with community pharmacy- or home-based interventions were excluded. Study quality was appraised using the Cochrane risk-of-bias tool. Random-effects models were applied to derive odds ratios (OR), with heterogeneity assessed using the I2 statistic and Cochrane's Q test.Results Eleven studies were included, involving 3576 patients and a variety of pharmacist interventions. Pharmacists significantly reduced the odds of all-cause hospitalizations compared to usual care (3472 patients, 927 events; OR 0.67, 95% confidence interval [CI]: 0.49-0.92, P = 0.0119). For HF hospitalizations (3442 patients, 504 events), similar results were retrieved (OR 0.64, 95% CI: 0.48-0.87, P = 0.0038). Heterogeneity was moderate for both analyses. Sensitivity analyses supported the robustness of these two analyses. Subgroup analyses indicated greater effectiveness in outpatient settings and when extended interventions were provided.Conclusions Across inpatient and outpatient settings, pharmacist interventions in HF significantly reduced all-cause as well as HF hospitalizations. Our findings highlight the importance of integrating pharmacists into multidisciplinary teams to improve HF management for in- and outpatients