Viewpoints and motives on religion and spirituality of professionals in perinatal medicine

Introduction Pregnancy and childbirth are unique experiences in a family’s lifetime. They are time periods of highest emotional sensitivity. Also, they may constitute substantial health risks for both the mother and the infant. With the advent of modern neonatal intensive care, ethical dilemmas have arisen more often in perinatology. Decisions on intensive vs. compassionate care for critically ill infants may have long-term emotional and mental health effects on parents. A questionnaire among parents of deceased newborns after delivery room resuscitation showed that predictions of morbidity and mortality were not central to their decision-making. However, religion, hope, spirituality and compassion were mentioned as being most valuable guidance to decision-making regarding delivery room resuscitation. Little is known about German professionals’ views regarding the role of religion and spirituality in perinatology. We therefore administered a cross sectional survey to medical professionals (midwives, nurses, obstetricians and neonatologists) who are working in perinatal medicine in Germany. Our study aims were to evaluate their perspectives on religion / spirituality and health as well as their personal religious and spiritual characteristics. Methods A modified version of a questionnaire on “religious characteristics of U.S. physicians” that was developed by Curlin et al. was used. The questionnaire was translated, adapted and validated. The questionnaire contained 47 items divided over three sections that evaluated personal perspective on religion/spirituality and health, personal religious and spiritual characteristics of the respondents and demographic characteristics. Results and conclusion Four study centers were enrolled in the study. There were 374 eligible participants, 296 medical professionals participated (78% response rate). Among these 296 professionals, 21 chose not to fill out the entire questionnaire. They used an abbreviated version of the questionnaire. This resulted in 275 active survey participants: 45 midwives (16%), 121 neonatal intensive care nurses (44%) and 109 physicians (neonatologists, obstetricians) (40%). The median age of all participants was 36 years (minimum 23, maximum 64, between center - range 41). 30% said to have no religious affiliation, 47% reported to be Roman Catholic, 18% Protestant and 5% indicated other religious affiliations. 10% reported to be very religious and 16% to be very spiritual, 47% reported to be moderately religious and 46% moderately spiritual, 21% slightly religious and 26% slightly spiritual and 22% reported to be not religious at all and 12% not spiritual at all. 96% of the survey participants think that R/S has an influence on health. They valued R/S mainly as something positive, that gives patients hope and helps to cope with and endure illness. Although the medical professionals valued R/S mainly as something positive only 50% of the medical professionals ever inquired about R/S issues. They were more likely to inquire about R/S issues when the clinical situation is more severe. Furthermore, medical professionals likelyhood to inquire about R/S issues seems related to their own spirituality and religious affiliation, those who are more spiritual are more likely to inquire about R/S issues. 40% of the participants noted that they experience barriers that discouraged them from discussing R/S issues with patients. Most frequently mentioned barriers were lack of time and training as well as general discomfort speaking about R/S issues and fear to offend patients. The study results suggest that educational programs should be made available to overcome such barriers. This study should encourage medical professionals in perinatal care to bring up religious and spiritual issues in patient care

Embedding human rights within a multinational company: The case of the international energy company Royal Dutch Shell

The first chapter of this dissertation introduces the context, relevance and focus of this research. In sections 1.1 to 1.3, the importance of multinational corporations (MNCs) in globalisation, the universality of human rights and the impact of business on human rights issues are discussed. Section 1.4 deals with the accountability of business regarding human rights under international law. The link between business and human rights with the trend of Corporate Social Responsibility is discussed in section 1.5. The debate on global standards versus voluntary initiatives is presented in section 1.6. In section 1.7, the focus of this research is described by presenting the research objectives and questions. Finally, the structure of the thesis is explained in section 1.8

Electrifying the green peace? Electrification, conservation and conflict in Eastern Congo

Large-scale infrastructure in conflict-affected states is often seen as a crucial means to pursue economic growth, poverty reduction, and increasingly, peace-building. Legitimated by an emergent 'Business for Peace' agenda, a variety of private actors now also engages in such infrastructure projects. The Virunga Alliance is such an initiative which aims to tackle the interlinked problems of poverty, conservation and conflict in the east of DR Congo through commercialised hydro-power. To take stock of the politics unfolding around such infrastructure efforts, this article analyses the Virunga Alliance as a form of 'technopolitics'. This entails tracing how current is generated, distributed and consumed, and how these processes generate new sites of power and control. In describing how Virunga offers a centralised, more concentrated supply of electricity as an alternative to the decentralised charcoal circuit, we show how electrification contributes to the expansion of a form of capitalism that prioritises big businessmen over small farmers, facilitates rent-seeking by political elites and amplifies social inequalities in Congo

Viewpoints and motives on religion and spirituality of professionals in perinatal medicine

Introduction Pregnancy and childbirth are unique experiences in a family’s lifetime. They are time periods of highest emotional sensitivity. Also, they may constitute substantial health risks for both the mother and the infant. With the advent of modern neonatal intensive care, ethical dilemmas have arisen more often in perinatology. Decisions on intensive vs. compassionate care for critically ill infants may have long-term emotional and mental health effects on parents. A questionnaire among parents of deceased newborns after delivery room resuscitation showed that predictions of morbidity and mortality were not central to their decision-making. However, religion, hope, spirituality and compassion were mentioned as being most valuable guidance to decision-making regarding delivery room resuscitation. Little is known about German professionals’ views regarding the role of religion and spirituality in perinatology. We therefore administered a cross sectional survey to medical professionals (midwives, nurses, obstetricians and neonatologists) who are working in perinatal medicine in Germany. Our study aims were to evaluate their perspectives on religion / spirituality and health as well as their personal religious and spiritual characteristics. Methods A modified version of a questionnaire on “religious characteristics of U.S. physicians” that was developed by Curlin et al. was used. The questionnaire was translated, adapted and validated. The questionnaire contained 47 items divided over three sections that evaluated personal perspective on religion/spirituality and health, personal religious and spiritual characteristics of the respondents and demographic characteristics. Results and conclusion Four study centers were enrolled in the study. There were 374 eligible participants, 296 medical professionals participated (78% response rate). Among these 296 professionals, 21 chose not to fill out the entire questionnaire. They used an abbreviated version of the questionnaire. This resulted in 275 active survey participants: 45 midwives (16%), 121 neonatal intensive care nurses (44%) and 109 physicians (neonatologists, obstetricians) (40%). The median age of all participants was 36 years (minimum 23, maximum 64, between center - range 41). 30% said to have no religious affiliation, 47% reported to be Roman Catholic, 18% Protestant and 5% indicated other religious affiliations. 10% reported to be very religious and 16% to be very spiritual, 47% reported to be moderately religious and 46% moderately spiritual, 21% slightly religious and 26% slightly spiritual and 22% reported to be not religious at all and 12% not spiritual at all. 96% of the survey participants think that R/S has an influence on health. They valued R/S mainly as something positive, that gives patients hope and helps to cope with and endure illness. Although the medical professionals valued R/S mainly as something positive only 50% of the medical professionals ever inquired about R/S issues. They were more likely to inquire about R/S issues when the clinical situation is more severe. Furthermore, medical professionals likelyhood to inquire about R/S issues seems related to their own spirituality and religious affiliation, those who are more spiritual are more likely to inquire about R/S issues. 40% of the participants noted that they experience barriers that discouraged them from discussing R/S issues with patients. Most frequently mentioned barriers were lack of time and training as well as general discomfort speaking about R/S issues and fear to offend patients. The study results suggest that educational programs should be made available to overcome such barriers. This study should encourage medical professionals in perinatal care to bring up religious and spiritual issues in patient care

Patient-Specific Vascular Flow Phantom for MRI- and Doppler Ultrasound Imaging

Objective:Intraoperative Doppler ultrasound imaging of human brain vasculature is an emerging neuro-imaging modality that offers vascular brain mapping with unprecedented spatiotemporal resolution. At present, however, access to the human brain using Doppler Ultrasound is only possible in this intraoperative context, posing a significant challenge for validation of imaging techniques. This challenge necessitates the development of realistic flow phantoms outside of the neurosurgical operating room as external platforms for testing hardware and softFware. An ideal ultrasound flow phantom should provide reference-like values in standardized topologies such as a slanted pipe, and allow for measurements in structures closely resembling vascular morphology of actual patients. Additionally, the phantom should be compatible with other clinical cerebrovascular imaging modalities. To meet these criteria, we developed and validated a versatile, multimodal MRI- and ultrasound Doppler phantom. Methods: Our approach incorporates the latest advancements in phantom research using tissue-mimicking material and 3D-printing with water-soluble resin to create wall-less patient-specific lumens, compatible for ultrasound and MRI. Results: We successfully produced three distinct phantoms: a slanted pipe, a y-shape phantom representing a bifurcating vessel and an arteriovenous malformation (AVM) derived from clinical Digital Subtraction Angiography (DSA)-data of the brain. We present 3D ultrafast power Doppler imaging results from these phantoms, demonstrating their ability to mimic complex flow patterns as observed in the human brain. Furthermore, we showcase the compatibility of our phantom with Magnetic Resonance Imaging (MRI). Conclusion: We developed an MRI- and Doppler Ultrasound-compatible flow-phantom using customizable, water-soluble resin prints ranging from geometrical forms to patient-specific vasculature.</p

MRI-Based Assessment of Brain Tumor Hypoxia:Correlation with Histology

Cerebral hypoxia significantly impacts the progression of brain tumors and their resistance to radiotherapy. This study employed streamlined quantitative blood-oxygen-level-dependent (sqBOLD) MRI to assess the oxygen extraction fraction (OEF)—a measure of how much oxygen is being extracted from vessels, with higher OEF values indicating hypoxia. Simultaneously, we utilized vessel size imaging (VSI) to evaluate microvascular dimensions and blood volume. A cohort of ten patients, divided between those with glioma and those with brain metastases, underwent a 3 Tesla MRI scan. We generated OEF, cerebral blood volume (CBV), and vessel size maps, which guided 3–4 targeted biopsies per patient. Subsequent histological analyses of these biopsies used hypoxia-inducible factor 1-alpha (HIF-1α) for hypoxia and CD31 for microvasculature assessment, followed by a correlation analysis between MRI and histological data. The results showed that while the sqBOLD model was generally applicable to brain tumors, it demonstrated discrepancies in some metastatic tumors, highlighting the need for model adjustments in these cases. The OEF, CBV, and vessel size maps provided insights into the tumor’s hypoxic condition, showing intertumoral and intratumoral heterogeneity. A significant relationship between MRI-derived measurements and histological data was only evident in the vessel size measurements (r = 0.68, p &lt; 0.001).</p

MRI-Based Assessment of Brain Tumor Hypoxia:Correlation with Histology

Cerebral hypoxia significantly impacts the progression of brain tumors and their resistance to radiotherapy. This study employed streamlined quantitative blood-oxygen-level-dependent (sqBOLD) MRI to assess the oxygen extraction fraction (OEF)-a measure of how much oxygen is being extracted from vessels, with higher OEF values indicating hypoxia. Simultaneously, we utilized vessel size imaging (VSI) to evaluate microvascular dimensions and blood volume. A cohort of ten patients, divided between those with glioma and those with brain metastases, underwent a 3 Tesla MRI scan. We generated OEF, cerebral blood volume (CBV), and vessel size maps, which guided 3-4 targeted biopsies per patient. Subsequent histological analyses of these biopsies used hypoxia-inducible factor 1-alpha (HIF-1α) for hypoxia and CD31 for microvasculature assessment, followed by a correlation analysis between MRI and histological data. The results showed that while the sqBOLD model was generally applicable to brain tumors, it demonstrated discrepancies in some metastatic tumors, highlighting the need for model adjustments in these cases. The OEF, CBV, and vessel size maps provided insights into the tumor's hypoxic condition, showing intertumoral and intratumoral heterogeneity. A significant relationship between MRI-derived measurements and histological data was only evident in the vessel size measurements (r = 0.68, p &lt; 0.001).</p

Neurocognitive functioning and radiologic changes in primary CNS lymphoma patients:results from the HOVON 105/ALLG NHL 24 randomized controlled trial

BACKGROUND: To analyze the effect of treatment on neurocognitive functioning and the association of neurocognition with radiological abnormalities in primary central nervous system lymphoma (PCNSL). METHODS: One hundred and ninety-nine patients from a phase III trial (HOVON 105/ALLG NHL 24), randomized to standard chemotherapy with or without rituximab, followed in patients ≤60 years old by 30-Gy whole-brain radiotherapy (WBRT), were asked to participate in a neuropsychological evaluation before and during treatment, and up to 2 years posttreatment. Scores were transformed into a standardized z-score; clinically relevant changes were defined as a change in z-score of ≥1 SD. The effect of WBRT was analyzed in irradiated patients. All MRIs were centrally assessed for white matter abnormalities and cerebral atrophy, and their relation with neurocognitive scores over time in each domain was calculated. RESULTS: 125/199 patients consented to neurocognitive evaluation. Statistically significant improvements in neurocognition were seen in all domains. A clinically relevant improvement was seen only in the motor speed domain, without differences between the arms. In the follow-up of irradiated patients (n = 43), no change was observed in any domain score, compared to after WBRT. Small but significant inverse correlations were found between neurocognitive scores over time and changes in white matter abnormalities (regression coefficients: −0.048 to −0.347) and cerebral atrophy (−0.212 to −1.774). CONCLUSIONS: Addition of rituximab to standard treatment in PCNSL patients did not impact neurocognitive functioning up to 2 years posttreatment, nor did treatment with 30-Gy WBRT in patients ≤60 years old. Increased white matter abnormalities and brain atrophy showed weak associations with neurocognition

Outcomes Associated With Intracranial Aneurysm Treatments Reported as Safe, Effective, or Durable:A Systematic Review and Meta-Analysis

Importance: Testing new medical devices or procedures in terms of safety, effectiveness, and durability should follow the strictest methodological rigor before implementation. Objectives: To review and analyze studies investigating devices and procedures used in intracranial aneurysm (IA) treatment for methods and completeness of reporting and to compare the results of studies with positive, uncertain, and negative conclusions. Data Sources: Embase, MEDLINE, Web of Science, and The Cochrane Central Register of Clinical Trials were searched for studies on IA treatment published between January 1, 1995, and the October 1, 2022. Grey literature was retrieved from Google Scholar. Study Selection: All studies making any kind of claims of safety, effectiveness, or durability in the field of IA treatment were included. Data Extraction and Synthesis: Using a predefined data dictionary and analysis plan, variables ranging from patient and aneurysm characteristics to the results of treatment were extracted, as were details pertaining to study methods and completeness of reporting. Extraction was performed by 10 independent reviewers. A blinded academic neuro-linguist without involvement in IA research evaluated the conclusion of each study as either positive, uncertain, or negative. The study followed Preferring Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Main Outcomes and Measures: The incidence of domain-specific outcomes between studies with positive, uncertain, or negative conclusions regarding safety, effectiveness, or durability were compared. The number of studies that provided a definition of safety, effectiveness, or durability and the incidence of incomplete reporting of domain-specific outcomes were evaluated.Results: Overall, 12 954 studies were screened, and 1356 studies were included, comprising a total of 410 993 treated patients. There was no difference in the proportion of patients with poor outcome or in-hospital mortality between studies claiming a technique was safe, uncertain, or not safe. Similarly, there was no difference in the proportion of IAs completely occluded at last follow-up between studies claiming a technique was effective, uncertain, or noneffective. Less than 2% of studies provided any definition of safety, effectiveness, or durability, and only 1 of the 1356 studies provided a threshold under which the technique would be considered unsafe. Incomplete reporting was found in 546 reports (40%).Conclusions and Relevance: In this systematic review and meta-analysis of IA treatment literature, studies claiming safety, effectiveness, or durability of IA treatment had methodological flaws and incomplete reporting of relevant outcomes supporting these claims.</p

Tocilizumab for the fifth progression of cystic childhood craniopharyngioma-a case report

We present the case of a 15-year-old girl, with a fifth cystic progression of an adamantinomatous craniopharyngioma after multiple surgeries and previous local radiotherapy. She had severe visual impairment, panhypopituitarism including diabetes insipidus, and several components of hypothalamic damage, including morbid obesity and severe fatigue. To prevent further late effects hampering her quality of survival, she was treated biweekly with intravenous tocilizumab, an anti-interleukin-6 agent, which stabilized the cyst for a prolonged time. Based on the biology of adamantinomatous craniopharyngioma, this immune-modulating treatment seems promising for the treatment of this cystic tumor in order to reduce surgery and delay or omit radiotherapy