Systemic sclerosis : from science to clinical practice

Het eerste doel van mijn promotieonderzoek is meer inzicht te krijgen in de noodzaak tot multidisciplinaire zorg in combinatie met orgaanscreening in pati_nten met systemische sclerose (SSc). Het tweede doel is het evalueren van de klinische waarde van enkele onderzoeken die een belangrijke rol spelen in de diagnostiek en follow-up van SSc. Het derde doel is het evalueren van enkele ziektemanifestaties van SSc. Het proefschrift beschrijft de resultaten van de pati_nten die participeren in het Zorgpad SSc. De pati_nten verwezen naar dit Zorgpad met een bevestigde diagnose SSc worden ge_ncludeerd in het Leiden Systemische Sclerose cohort. De bevindingen van de eerste 226 pati_nten ge_ncludeerd in dit cohort zijn beschreven in dit proefschrift. Op basis van de resultaten van mijn promotieonderzoek kan worden geconcludeerd dat een beter bewustzijn van de ziekte SSc noodzakelijk is. Dit kan bereikt worden door meer bekendheid met de ziekte in bepaalde pati_nten groepen, waaronder pati_nten met sarco_dose en siliconen borst implantaten. Maar ook door de combinatie van multidisciplinaire zorg en uitgebreide orgaanscreening voor pati_nten reeds gediagnosticeerd met SSc. Daarbij lijken het nagelriemonderzoek en de fietstest mogelijk goede biomarkers te zijn voor respectievelijk respons op behandeling en progressieve ziekte.UBL - phd migration 201

Public Perception of Who is a Volunteer : An Examination of the Net-cost Approach from a Cross-Cultural Perspective

Volunteers are the cornerstones on which the voluntary sector is predicated. We are accustomed to using this phrase in every aspect of our lives, yet too little systematic work has been carried out to define this term in a rigorous and precise manner. Volunteering is the essence of the scholarly work of numerous academicians around the world, however there are many issues that arise when people report their own volunteering or attempt to define the term volunteer. No clear-cut definition that encompasses all aspects of volunteering exists. Often too many different activities and situations are aggregated into this concept (Cnaan, Handy, & Wadsworth, 1996; Scheier, 1980; Smith, 1995; Tremper, Seidman, & Tufts, 1994; Vineyard, 1993)

Manipulating word awareness dissociates feed-forward from feedback models of language-perception interactions

Previous studies suggest that linguistic material can modulate visual perception, but it is unclear at which level of processing these interactions occur. Here we aim to dissociate between two competing models of language–perception interactions: a feed-forward and a feedback model. We capitalized on the fact that the models make different predictions on the role of feedback. We presented unmasked (aware) or masked (unaware) words implying motion (e.g. “rise,” “fall”), directly preceding an upward or downward visual motion stimulus. Crucially, masking leaves intact feed-forward information processing from low- to high-level regions, whereas it abolishes subsequent feedback. Under this condition, participants remained faster and more accurate when the direction implied by the motion word was congruent with the direction of the visual motion stimulus. This suggests that language–perception interactions are driven by the feed-forward convergence of linguistic and perceptual information at higher-level conceptual and decision stages

Buitenland : het IBRA Congres over Tropische bijen

Van 19 tot en met 25 maart vond in Chiang Mai (in het noorden van Thailand) het 7de congres van de IBRA over tropische bijen plaats. Het congres werd gecombineerd met het congres van de Aziatische Bijenhouders Associatie. In het Lotus hotelcomplex werd tevens de Bee World Expo 2000 gehouden. Een kleine groep Nederlandse imkers nam deel aan dit congres en doet hiervan verslag

The Tsunami’s CSR Effect: MNEs and Philanthropic Responses to the Disaster

This paper contributes to the literature on CSR and International Business by linking firm internationalization to corporate philanthropy. Considering the 2004 Tsunami disaster as a highly relevant case of an international societal issue, we analyze the characteristics of the corporate response to the disaster among Fortune Global 500 firms. We find that home region, degree of internationalization, firm size and profitability most strongly influenced the propensity of firms to donate as well as the value of their donations

Contaminants and micro-organisms in organic and conventional food products

In the Netherlands we investigated animal and plant products on potentially hazardous contamination with heavy metals, mycotoxins, pesticide residues, patho-genic micro-organisms and nitrate. In most cases, the organically produced foods had equal or lower amounts of contaminants than conventionally pro-duced products. These results conflict with a common idea that organic farming theoretically increases food safety risks. For many contaminants organic food showed a large diversity in the amount of contamina-tion. Experience with organic farming, managing and manure use partly explain these differences. Understanding of these cultivation parameters can help in further improvement of organic cultivation practices

Predicting COVID-19 prognosis in the ICU remained challenging: external validation in a multinational regional cohort

Objective: Many prediction models for Coronavirus Disease 2019 (COVID-19) have been developed. External validation is mandatory before implementation in the Intensive Care Unit (ICU). We selected and validated prognostic models in the Euregio Intensive Care COVID (EICC) cohort. Study design and setting: In this multinational cohort study, routine data from COVID-19 patients admitted to ICUs within the Euregio Meuse-Rhine were collected from March to August 2020. COVID-19 models were selected based on model type, predictors, outcomes, and reporting. Furthermore, general ICU scores were assessed. Discrimination was assessed by area under the receiver operating characteristic curves (AUCs) and calibration by calibration-in-the-large and calibration plots. A random-effects meta-analysis was used to pool results. Results: 551 patients were admitted. Mean age was 65.4±11.2 years, 29% were female, and ICU mortality was 36%. Nine out of 238 published models were externally validated. Pooled AUCs were between 0.53 and 0.70 and calibration-in-the-large between -9% and 6%. Calibration plots showed generally poor but, for the 4C Mortality score and SEIMC score, moderate calibration. Conclusion: Of the nine prognostic models that were externally validated in the EICC cohort, only two showed reasonable discrimination and moderate calibration. For future pandemics, better models based on routine data are needed to support admission decision-making

Discovering Distinct Phenotypical Clusters in Heart Failure Across the Ejection Fraction Spectrum:a Systematic Review

Review Purpose: This systematic review aims to summarise clustering studies in heart failure (HF) and guide future clinical trial design and implementation in routine clinical practice. Findings: 34 studies were identified (n = 19 in HF with preserved ejection fraction (HFpEF)). There was significant heterogeneity invariables and techniques used. However, 149/165 described clusters could be assigned to one of nine phenotypes: 1) young, low comorbidity burden; 2) metabolic; 3) cardio-renal; 4) atrial fibrillation (AF); 5) elderly female AF; 6) hypertensive-comorbidity; 7) ischaemic-male; 8) valvular disease; and 9) devices. There was room for improvement on important methodological topics for all clustering studies such as external validation and transparency of the modelling process.Summary:The large overlap between the phenotypes of the clustering studies shows that clustering is a robust approach for discovering clinically distinct phenotypes. However, future studies should invest in a phenotype model that can be implemented in routine clinical practice and future clinical trial design. Graphical Abstract: HF = heart failure, EF = ejection fraction, HFpEF = heart failure with preserved ejection fraction, HFrEF = heart failure with reduced ejection fraction, CKD = chronic kidney disease, AF = atrial fibrillation, IHD = ischaemic heart disease, CAD = coronary artery disease, ICD = implantable cardioverter-defibrillator, CRT = cardiac resynchronization therapy, NT-proBNP = N-terminal pro b-type natriuretic peptide, BMI = Body Mass Index, COPD = Chronic obstructive pulmonary disease. [Figure not available: see fulltext.]</p

Age-related improvement in complex language comprehension: Results of a cross-sectional study with 361 children aged 5 to 15

We investigated age-related improvement in speed and accuracy of complex language comprehension with 361 children attending kindergarten and the 2nd, 4th, 6th, 7th, and 8th grades. Language comprehension was measured using both the neuropsychological procedure proposed by Luria (1966, 1980) and an adapted version of the Token Test. Levels of short-term memory and verbal intelligence were controlled for in the evaluation of language comprehension. The findings show that the accuracy of language comprehension continued to develop until the 6th grade, whereas the speed of language comprehension continued to improve up until the 7th grade. We thus conclude that the complex language comprehension of children is not fully developed until early adolescence. We further contend that the speed of complex language comprehension appears to be more sensitive than accuracy with respect to measuring developmental differences

Baseline MDCT findings after prosthetic heart valve implantation provide important complementary information to echocardiography for follow-up purposes

Objectives: Recent studies have proposed additional multidetector-row CT (MDCT) for prosthetic heart valve (PHV) dysfunction. References to discriminate physiological from pathological conditions early after implantation are lacking. We present baseline MDCT findings of PHVs 6 weeks post implantation. Methods: Patients were prospectively enrolled and TTE was performed according to clinical guidelines. 256-MDCT images were systematically assessed for leaflet excursions, image quality, valve-related artefacts, and pathological and additional findings. Results: Forty-six patients were included comprising 33 mechanical and 16 biological PHVs. Overall, MDCT image quality was good and relevant regions remained reliably assessable despite mild-moderate PHV-artefacts. MDCT detected three unexpected valve-related pathology cases: (1) prominent subprosthetic tissue, (2) pseudoaneurysm and (3) extensive pseudoaneurysms and valve dehiscence. The latter patient required valve surgery to be redone. TTE only showed trace periprosthetic regurgitation, and no abnormalities in the other cases. Additional findings were: tilted aortic PHV position (n = 3), pericardial haematoma (n = 3) and pericardial effusion (n = 3). Periaortic induration was present in 33/40 (83 %) aortic valve patients. Conclusions: MDCT allowed evaluation of relevant PHV regions in all valves, revealed baseline postsurgical findings and, despite normal TTE findings, detected three cases of unexpected, clinically relevant pathology. Key Points: • Postoperative MDCT presents baseline morphology relevant for prosthetic valve follow-up. • 83 % of patients show periaortic induration 6 weeks after aortic valve replacement. • MDCT detected three cases of clinically relevant pathology not found with TTE. • Valve dehiscence detection by MDCT required redo valve surgery in one patient. • MDCT is a suitable and complementary imaging tool for follow-up purposes