The Diabetes and WELLbeing programme: protocol of a multi-site European complex intervention study

A quasi-experimental design evaluation study examines long-term impact of the 12-week DWELL programme, a self-management intervention for people with type 2 diabetes (T2D), based on adult learning and person-centred approaches, delivered in 5 community and hospital sites in 4 European countries. Overall target is 780 people with T2D. Staff are trained in motivational interviewing, group facilitation, diabetes education, and programme approach which consists of core and ‘pick and mix’ sessions on diabetes education, physical activity, healthy eating and wellbeing. Pre-post measures are taken at baseline (T0), end-of-programme (T1), at 6 months (T2) and 12 months (T3). There is a non-equivalent control group of 190 at T2/T3. Biomedical data are collected by staff and psychosocial data are collected via self-completed validated scales. Metabolic measures include: HbA1c, BMI and waist circumference. Demographics capture: age, gender, ethnicity, household composition, education, employment, income. Psychosocial data are collected on illness perception, patient empowerment, eating behaviours, physical activity, physical/mental health status, health-related quality of life (EQ-5D), use of diabetes-related health services and self-care activities. Participant experiences are recorded via motivational interviews at T0 and T1 and focus groups at T1. Process evaluation data are collected via interviews with staff and patient ambassadors. The DWELL programme started in 2018 and results will be available in 2021. The study will produce rich data on long-term impact of intervention to allow replication and further development. It will permit cross-border conclusions on sustainability and embeddedness of model in varied service settings, and empowerment-based public health approach to T2D self-management

Treatment of patch infection after carotid endarterectomy:a systematic review

Carotid endarterectomy (CEA) with patch angioplasty is a widely used method for treating carotid artery stenosis. Patch infections are extremely rare, but the consequences may be serious. The current gold standard for treatment is patch excision and reconstruction with autologous material. However, no consensus has been reached and other options may be valuable as well in certain cases. The objective of this study was to evaluate the various treatment options for carotid patch infection after CEA with patch angioplasty on the basis of their outcomes (reinfection, ischemic stroke, and infection-related mortality). This systematic review was conducted in accordance with the PRISMA statement. The electronic bibliographic databases PubMed, Cochrane, and EMBASE were searched. Case series and case reports were included. Studies in languages other than English were excluded. Patients who developed a post-operative patch infection of CEA with patch angioplasty were included. Angioplasty could be performed with any type of patch. Patch infection needed to be confirmed by clinical presentation in combination with imaging, culture, or during the operation. The primary outcome measures were reinfection, ischemic stroke, and infection-related mortality. Eleven retrospective case series, two prospective case series, and seventeen case reports were included. The study size was 165 patients (mean age 69.7 years, M/F ratio 1.75:1). One hundred and seventy-one patches developed a patch infection after CEA with patch angioplasty and needed treatment. Treatment strategies included conservative treatment (14.0%), endovascular treatment (4.7%), and open surgery (81.4%). Mean follow-up was 34.8 months and extended up to 180 months. Reinfection rate was 4.7%, ischemic stroke rate 5.8%, and infection-related mortality rate 2.3%. No statistical comparison between treatment options could be performed, because of the heterogeneity of the included studies. Autologous material should be the primary choice of treatment if patch infection is diagnosed after CEA with patch angioplasty. In emergency situations, endovascular treatment, carotid ligation, or abscess drainage could be considered. Endovascular treatment and abscess drainage are temporary solutions. After the patient has recovered sufficiently, a more durable treatment i.e., open surgery is advised. Endo vacuum assisted closure (EndoVAC) seems to be promising. Further research is needed to determine the applicability of each treatment option.</p

Cirrhotic livers reveal genetic changes in the MDM2-P14ARF system of cell cycle regulators

The genesis of hepatocellular carcinoma is promoted by changes in the regulatory MDM2-P14ARF system. The incidence of such changes has to date not been analysed in non-tumourous livers showing regenerative proliferation. In the present study, 24 cirrhotic livers of alcohol-, autoimmue disorder- or HCV-caused genesis were screened for MDM2-P14ARF alterations at the level of protein, DNA and mRNA. Using confocal laser scanning microscopy, the absence of MDM2 and P14ARF expression was detected in all samples except three HCV-infected livers (four livers) which contained hepatocytes overexpressing MDM2 (P14ARF) protein. In two of the samples lacking P14ARF expression, laser microdissection and PCR demonstrated deletion of the P14ARF gene. The P14ARF gene amplified from other specimens did not carry mutations. MDM2 splicing variants were present in tissues from alcohol- and autoimmune disorder-induced cirrhoses. Sequencing of full-size mRNA revealed a MDM2 mis-sense mutation in an alcohol-induced cirrhosis. One sample contained regenerative nodules with genetic instability occurring at MDM2 locus D12S83 according to the data of automatic PCR fragment analysis. In summary, this study gives first evidence for different types of MDM2 and P14ARF alterations in cirrhotic livers. We suggest that the changes impair the regulatory MDM2-P14ARF system, thus possibly favouring regenerative proliferation and transformation

[Modellering van subrosie en grondwaterstroming in de nabijheid van de Zuidwending zoutpijler gebaseerd op geometrische en (paleo)hydrologische randvoorwaarden voor noordoost Nederland. Eindrapport van het SESAM project.]

Abstract niet beschikbaarThe SESAM project was intended to perform a local model validation using site specific geological and (palaeo)hydrological boundary conditions in relation to the release of radionuclides from a waste repository in rock salt into the geosphere. The project was conducted by the RIVM, RGD, and IGG-TNO. Groundwater flow models are constructed for two selected areas: A regional model of the subsurface of the NE part of the Netherlands and a local model of the surroundings of the Zuidwending diapir. The models are constructed on the basis of geological and palaeo-environmental information, provided by the RGD. The steady-state regional groundwater flow for the present time and six Late Quaternary geological periods in the northeastern part of the Netherlands are simulated by IGG-TNO with the slightly adapted MODFLOW code. These studies provided the side flow boundary conditions for the local RIVM model, in which flow and transport in the vicinity of the selected diapir are examined with the METROPOL-3 model. Similar to current international standards with respect to safety assessment studies, the local model consists of i) a conceptual model, ii) a computer code, and iii) site-specific data sets. Emphasis has been put on calibration for present day conditions, detailed sensitivity analyses, simulation of flow and transport during six Late Quaternary geological periods, and a comparison of calculated subrosion rates with values reported in the literature. The simulations for the regional model showed that the potential gradients in the interglacial periods are considerably less than those in the periglacial periods. The largest groundwater velocities occurred during the Late Saalian. Application of the 3D local model resulted in an asymptotically decreasing subrosion rate of 0.12 mm/year after a simulation period of 50.000 years. The order of magnitude of the subrosion rates obtained with the METROPOL-3 code is the same as reported for other Dutch and German diapirs on the basis of geological methods. A sensitivity analysis indicated the side boundary fluxes and the permeabilities of the geological layers as te most sensitive parameters. As a consequence of the limited availability of data, complete validation of the local site-specific model is considered very difficult. For a meaningful calibration more filed data in the vicinity of the salt diapir are needed. Most essential are new data on the salt mass fraction distribution near the dome.DGM/SVS EZ/Cie OPL

De ontwikkeling van een analysekader voor het evidence informed herontwerpen van W&T-onderwijs

Overgenomen uit: Tijdschrift voor Lerarenopleiders, 2021, nr. 3Pabo&rsquo;s dienen ervoor te zorgen dat toekomstige leraren in staat zijn onderwijs in Wetenschap en Technologie (W&amp;T) te verzorgen. Aangezien meer dan driekwart van de scholen werkt met een methode op het gebied van W&amp;T, is het belangrijk dat aanstaande leraren leren de kwaliteit van dit materiaal wetenschappelijk ge&iuml;nformeerd te analyseren en te verbeteren. In deze &lsquo;good practice&rsquo;-beschrijving wordt de opzet en uitvoering van een project rondom het wetenschappelijk ge&iuml;nformeerd analyseren van W&amp;T-leermateriaal besproken. De stappen die zijn gevolgd in dit project, worden stuk voor stuk toegelicht. Na het belichten van iedere stap wordt steeds uitgewerkt hoe ermee gewerkt kan worden in de lerarenopleiding. Hiertoe worden steeds concrete opdrachtsuggesties geboden. De voorgestelde opdrachten zorgen voor de integratie van theorie en praktijk, en dragen bij aan de systematische en doelgerichte bevordering van de vakinhoudelijke, pedagogisch-didactische alsook onderzoekscompetenties van aanstaande leraren basisonderwijs. Door de opdrachten op te nemen in het pabo-curriculum wordt bijgedragen aan meer en beter evidence ge&iuml;nformeerd onderwijs op de pabo &eacute;n in het basisonderwij

All-cause and cause-specific mortality among people with and without intellectual disabilities during the COVID-19 pandemic in the Netherlands: a population-based cohort study.

BACKGROUND: Although high rates of COVID-19-related deaths have been reported for people with intellectual disabilities during the first 2 years of the pandemic, it is unknown to what extent the pandemic has impacted existing mortality disparities for people with intellectual disabilities. In this study, we linked a Dutch population-based cohort that contained information about intellectual disability statuses with the national mortality registry to analyse both cause-specific and all-cause mortality in people with and without intellectual disabilities, and to make comparisons with pre-pandemic mortality patterns. METHODS: This population-based cohort study used a pre-existing cohort that included the entire Dutch adult population (everyone aged ≥18 years) on Jan 1, 2015, and identified people with presumed intellectual disabilities through data linkage. For all individuals within the cohort who died up to and including Dec 31, 2021, mortality data were obtained from the Dutch mortality register. Therefore, for each individual in the cohort, information was available about demographics (sex and date of birth), indicators of intellectual disability, if any, based on chronic care and (social) services use, and in case of death, the date and underlying cause of death. We compared the first 2 years of the COVID-19 pandemic (2020 and 2021) with the pre-pandemic period (2015-19). The primary outcomes in this study were all-cause and cause-specific mortality. We calculated rates of death and generated hazard ratios (HRs) using Cox regression analysis. FINDINGS: At the start of follow-up in 2015, 187 149 Dutch adults with indicators of intellectual disability were enrolled and 12·6 million adults from the general population were included. Mortality from COVID-19 was significantly higher in the population with intellectual disabilities than in the general population (HR 4·92, 95% CI 4·58-5·29), with a particularly large disparity at younger ages that declined with increasing age. The overall mortality disparity during the COVID-19 pandemic (HR 3·38, 95% CI 3·29-3·47) was wider than before the pandemic (3·23, 3·17-3·29). For five disease groups (neoplasms; mental, behavioural, and nervous system; circulatory system; external causes; and other natural causes) higher mortality rates were observed in the population with intellectual disabilities during the pandemic than before the pandemic, and the pre-pandemic to during the pandemic difference in mortality rates was greater in the population with intellectual disabilities than in the general population, although relative mortality risks for most other causes remained within similar ranges compared with pre-pandemic years. INTERPRETATION: The impact of the COVID-19 pandemic on people with intellectual disabilities has been greater than reflected by COVID-19-related deaths alone. Not only was the mortality risk from COVID-19 higher in people with intellectual disabilities than in the general population, but overall mortality disparities were also further exacerbated during the first 2 years of the pandemic. For disability-inclusive future pandemic preparedness this excess mortality risk for people with intellectual disabilities should be addressed. FUNDING: Dutch Ministry of Health, Welfare, and Sport and Netherlands Organization for Health Research and Development

Lead knee extension contributes to drag-flick performance in field hockey

Understanding the biomechanics of the drag-flick is important for refining the performance of this task in field hockey. The aim of this study was to determine whether the maximal knee angle and maximal angular velocity of the lead knee extension are associated with ball speed in elite drag-flick players. The kinematics of the drag flick was studied in 19 elite field-hockey players who performed 15 drag-flick shots each towards a target located 1.30 m high at optimal speed. A motion capture suit was used to capture full body drag-flick behaviour sampling at 240 Hz. Multiple regression analyses were used to study the association between both the maximal knee flexion angle and maximal angular velocity of the leading knee extension and ball speed. Significant positive associations were found between knee extension velocity and ball speed (R2 =.127, p &lt;.001). A higher knee extension velocity resulted in higher ball speeds within the individual, without negatively affecting the accuracy. It is advised to train, within an elite drag-flick group, for higher knee extension speed to improve the drag-flick performance. Whether training to improve this parameter results in higher ball speeds should be subject of future studies.Biomechanical EngineeringBiomechatronics & Human-Machine Control(OLD) CRE Building & Installation