"Killing in the Name of 3R?" The Ethics of Death in Animal Research

Changing relationships with nonhuman animals have led to important modifications in animal welfare legislations, including the protection of animal life. However, animal research regulations are largely based on welfarist assumptions, neglecting the idea that death can constitute a harm to animals. In this article, four different cases of killing animals in research contexts are identified and discussed against the background of philosophical, societal, and scientific-practical discourses: 1. Animals killed during experimentation, 2. Animals killed before research, 3. "Surplus" animals and 4. "Leftover" animals. The scientific community and, accordingly, animal research regulations such as the internationally acknowledged framework 3R ("Replace", "Reduce", "Refine") tend to aim at the reduction of "surplus" and, to some extent, "leftover" animals, whereas the first two classes are rather neglected. However, the perspective that animal death matters morally is supported by both societal moral intuitions and certain theoretical accounts in animal ethics. Therefore, we suggest the implementation of the 3Rs in regulations, so that they: 1. Make their underlying philosophical position transparent; 2. Are based on a weighing account of animal death; 3. Are applicable to procedures on living and dead animals; 4. Apply the "reduction" principle to procedures on dead animals; 5. Entail that methods using (parts of) dead animals need to be replaced by animal free methods, if possible; 6. Do not suggest replacing research on living animals by research on killed animals; 7. Include all kinds of animals, depending on the respective harm of death; 8. Are applied to the broader context of experimentation, including breeding and the fate of the animals after the experiment

Assessing personal recovery in individuals with severe mental illness:validation of the Dutch Brief INSPIRE-O

PurposeRecovery is a key objective in mental health services for people with severe mental illness (SMI). In addition to clinical and functional recovery, personal recovery has gained increasing attention. The CHIME Framework identifies five personal recovery processes-Connectedness, Hope, Identity, Meaning, Empowerment-and is the theoretical foundation for the Brief INSPIRE, a validated Patient-Rated Experience Measure (PREM) to evaluate recovery support. Brief INSPIRE was modified to a five-item Patient-Rated Outcome Measure (PROM) assessing recovery, called Brief INSPIRE-Outcome (Brief INSPIRE-O). Subject of this study are the psychometric properties of the Brief INSPIRE-O.MethodsData on validity and reliability gathered through annual routine outcome monitoring were collected for 861 individuals with SMI of Flexible Assertive Community Treatment teams and a follow-up measurement was available for 232 of these individuals. Test-retest reliability was evaluated in a separate subset of 30 individuals with SMI.ResultsThe Brief INSPIRE-O shows good internal consistency (Cronbach's alpha 0.77), test-retest reliability, construct validity, sensitivity to change and no floor or ceiling effects. Furthermore, change in Brief INSPIRE-O was positively related to changes in quality of life and negatively to problems in clinical functioning and unmet care need.ConclusionBrief INSPIRE-O can be used for research and monitoring to better understand and improve processes of personal recovery in individuals with SMI

Identifying the Added Value and Requirements of Telerehabilitation in Home-based Geriatric Rehabilitation:An Exploratory Qualitative Study

Geriatric rehabilitation (GR) facilities are turning to innovative tools such as telerehabilitation to support home-based treatment due to challenges with population ageing, staff shortages, and mounting budgetary pressures. This study identified the potential added value as well as the requirements of using telerehabilitation in home-based GR, according to stakeholders and potential end-users. This exploratory qualitative study design conducted semi-structured interviews among nineteen care professionals, three patients and one informal caregiver. The qualitative data from these interviews were transcribed verbatim and analysed with inductive content analysis. Interviewees indicated multiple added values and requirements for telerehabilitation in home-based GR. Overall, there was great emphasis on blended care implementation, in which telerehabilitation is used in conjunction with in-person care. It is recommended to use the present findings towards developing and implementing a telerehabilitation intervention in home-based GR and assess its feasibility and usability

Ultrasound B-Scan for Posterior Segment and Extraocular Evaluation in Ocular Cysticercosis

Purpose: Cysticercosis, caused by Taenia solium larvae, can affect various ocular and extraocular structures, leading to significant morbidity. Ultrasound B-scan imaging plays a pivotal role in diagnosing and classifying cysticercosis lesions. The aim of the study was to describe the ultrasound B-scan characteristics of ocular and extraocular cysticercosis, proposing a classification system based on anatomical localization to enhance understanding and management. Patients and Methods: A retrospective study of consecutive cases with intraocular or extraocular cysticercosis was conducted from January 1993 to December 2023 in Mumbai, India. B-scan ultrasound was performed by an experienced imaging specialist. Descriptive statistics were used to summarize demographic characteristics and the proportion of cysticercosis in each anatomical location. Cysticercosis lesions were classified based on anatomical location observed during imaging. Results: Amongst the 56 eyes evaluated, intraocular posterior segment involvement (n=25) and extraocular involvement (n=31) were observed. Extraocular cysticercosis predominantly affected the medial rectus muscle (40%), followed by the inferior rectus (28%), lateral rectus (20%), and superior rectus muscles (12%). Orbital cysts were localized in the posterior extraconal (50%), anterior extraconal (34.33%), and intraconal (16.67%) regions. Intra-vitreous cysticercosis (n=9) exhibited thin-walled cysts with minimal inflammation, progressing to thickened cyst walls in the late stages. Sub-hyaloid cysticercosis (n=8) showed initial thin vitreous detachment, progressing to thickened vitreous adhesions. Sub-retinal cysticercosis (n=9) without retinal detachment indicated early disease, while cases with detachment suggested disease progression. Conclusion: The proposed anatomical classification system based on B-scan ultrasound features provides a structured approach to categorizing cysticercosis lesions, enhancing understanding and management in ophthalmic practice

Navigating contradictions:justifications and imaginaries of the initiators of European migration information campaigns

European states employ migration information campaigns (MICs) to discourage irregular migration to Europe by people from the Global South. Campaigns are justified by their initiators in various ways. On the one hand, campaigns are said to protect ‘potential migrants’ by helping them to make informed decisions (‘care’). On the other hand, campaigns respond to Europe's security objective of restricting migration flows (‘control’). Researchers have looked at various intermediaries involved in these campaigns. Yet, little attention has been given to individual European policy actors who decide on the funding and design of campaigns and how they navigate between campaigns' contradictory intentions to care for ‘potential migrants’ and to control borders. How do European campaign initiators justify the need for MICs? And what does this tell us about the migration imaginaries of those who develop migration governance measures? Based on interviews with European policymakers and campaign designers in the Netherlands and Senegal, this article examines their discursive acts of legitimation. It shows that in justifying their everyday work, they imagine themselves as humanitarian actors, and ‘potential migrants’ as depoliticized subjects in need of care. While initiators do sometimes examine campaigns critically, they build a worldview in which care is instrumental to border enforcement and in which compassion becomes a form of repressive ‘soft’ bordering.</p

Breast implant illness revisited:A cohort study of health symptoms in women with implant-based reconstruction

Background: This study investigated the association between silicone breast implants and health symptoms believed to be related to breast implant illness (BII) in women who underwent implant-based breast reconstruction after breast cancer. Although there is increasing evidence of an association between BII and breast augmentation cases, it is unclear in women with implant-based breast reconstruction. Methods: This retrospective cohort study involved 254 women who underwent implant-based reconstruction after breast cancer treatment and a control group comprising 487 women who underwent breast-conservation therapy or simple mastectomy. We linked Dutch Breast Implant Registry data (2015–2019) and general practice electronic health records data (2014–2022) to study the occurrence of 13 BII-related health symptoms in general practice and number of consultations for these symptoms 1 year before to 3 years after breast surgery. Results: Over the 3 years following implantation, no significant differences in symptom occurrence were observed when comparing the data from year before implantation and the control group. Women with breast implants did not have more consultations in general practice compared to the control group during follow-up. However, there was an increased likelihood of having =3 consultations in the first and second years post-implantation compared to that before implantation. Conclusions: This is the first study on BII focusing solely on women who underwent implant-based reconstruction after breast cancer. We found no evidence for BII in this patient group. However, BII symptoms may not manifest within the 3-year timeframe but could emerge later, which warrants further research with longer follow-up

Long-term risk of endometrial cancer after assisted reproductive technology

STUDY QUESTION: What is the risk of endometrial cancer after long-term follow-up in women treated with ART between 1983 and 2001 compared with women in the general population and subfertile women who did not undergo ART? SUMMARY ANSWER: The risk of endometrial cancer is not increased in women who underwent ART in the Netherlands between 1983 and 2001, neither compared with women from the general population nor compared with subfertile women not treated with ART. WHAT IS KNOWN ALREADY: Concerns have been raised that subfertility treatment may be associated with increased risk of endometrial cancer. However, published studies show inconsistent results regarding the effects of ovarian stimulation and specific subfertility diagnoses on endometrial cancer risk. STUDY DESIGN, SIZE, DURATION: A nationwide historic cohort study (the OMEGA-cohort) was conducted to examine the risk of cancer in women after ovarian stimulation for ART. The OMEGA-cohort comprises 30 625 women who received ovarian stimulation for ART (ART group) in 1983–2000 and 9988 subfertile women not treated with ART (non-ART group). After a median follow-up of 24 years, endometrial cancer incidence was ascertained through linkage with the Netherlands Cancer Registry. Endometrial cancer risk in the cohort was compared with that in the general population using person-years analyses, and between the ART group and non-ART group using multivariable Cox regression analyses. PARTICIPANTS/MATERIALS, SETTING, METHODS: Detailed ART-treatment data were obtained from the medical records and complete information on parity and age at first birth was obtained through linkage with the Personal Records Database. Information on hysterectomy and endometriosis was collected through linkage with the Dutch Nationwide Pathology Databank (Palga). Data about lifestyle factors, including BMI, were obtained through a self-administered questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE: After a median follow-up duration of 24 years, 137 endometrial cancers were diagnosed. Endometrial cancer risk after ART was not significantly increased compared with that in the general population (standardized incidence ratio = 1.19; 95% CI = 0.97–1.44) nor compared with that in the non-ART group (multivariably adjusted hazard ratio = 1.11; 95% CI = 0.74–1.67). Risk of endometrial cancer did not increase with longer follow-up or with more ART cycles, and the risk within the cohort, did not vary by cause of subfertility (male, tubal, unexplained, and other). Irrespective of ART treatment, endometrial cancer risk was increased in obese women and women with endometriosis, but decreased among parous women and women who used oral contraceptives. LIMITATIONS, REASONS FOR CAUTION: Although the findings of the study are reassuring, the median age of the women at the end of follow-up (median age 56 years) was still rather young. Therefore, there is a need for at least 10–15 additional follow-up years to draw definitive conclusions. In addition, other large studies are needed to investigate the risk of endometrial cancer in women who underwent ART. WIDER IMPLICATIONS OF THE FINDINGS: The results of this study contribute to knowledge about long-term health after ART treatment, which is valuable to subfertile couples, considering or undergoing fertility treatments, and their healthcare providers.</p

Transferability of green port strategies:A Delphi study with European ports

This research aims to identify suitable green port strategies for small EU ports, by first examining green port strategies of leading European ports and then their applicability in the context of small ports, by assessing challenges and barriers encountered during strategy implementation. Several port environmental issues were identified, including 12 green port strategies and their corresponding port emission areas. Two rounds of a Delphi study, namely a survey and semi-structured validation interviews were conducted with 21 experts from four European ports, to understand port characteristics, examine the applicability of the strategies, and identify challenges and barriers associated with their implementation. In total, six strategies are deemed suitable for application in small ports, specifically renewable energy, clean power vehicles, waste management, slow steaming, modal shifting, and incentives for green trucks. By identifying green port strategies applicable to small ports, based on small port characteristics and implementation challenges arising from these, this research addresses a gap in academic literature. We provide small port management and relevant stakeholders with a list of applicable innovations and growth policies essential for achieving green port status