International Migration, Integration and Social Cohesion online publications
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Out-of-hospital cardiac arrest in women and men:Risk factors, short-term survival, and long-term outcomes
Get PDFLarge sex differences exist in incidence and survival chances of out-of-hospital cardiac arrest (OHCA). Survival rates have increased in recent decades, but it is unclear whether both sexes have benefitted equally. Besides biology, sociocultural factors or improvements in pre-hospital and in-hospital care may contribute to sex differences. Pre-hospital care involves timely start of cardiopulmonary resuscitation, but also guidelines for termination of resuscitation. Further, the rising number of OHCA survivors requires attention for the long-term socioeconomic and mental health changes post-OHCA. Understanding OHCA’s impact on long-term survival can aid design of targeted interventions for women and men. This thesis aimed to assess the OHCA burden in women and men, focusing on the association of sociocultural factors with incidence, and sex differences in short-term survival, and long-term outcomes. Our studies confirmed differences between women and men. For instance, sociocultural characteristics were associated with OHCA incidence, especially among women. Moreover, the short-term survival rates increased for men over time, while remaining unchanged in women. This was associated with differences in proportions of shockable initial rhythm and in-hospital interventions. However, guidelines for termination of resuscitation were equally applicable in both sexes. In the long-term, employment rates and income decreased in women and men, mirroring general population trends, while dispensing of anxiety/depression medication increased disproportionately in women. Long-term survival rates post-OHCA did not differ by sex, but factors associated with survival were sex-specific. Our work may provide targets for prevention and treatment strategies to mitigate sex disparities in OHCA incidence, survival and long-term outcomes
From standard pots to potters' standards:An integrated approach to ceramic standardization and change in Archaic Satricum (6th–4th century BC)
Get PDFThe dissertation examines the transformative processes of Archaic Central Italy, focusing on the ancient city of Satricum, present-day Borgo Le Ferriere in Southern Lazio, Italy. Spanning nearly ten centuries from the Iron Age to the early Imperial period, Satricum offers a unique lens into Latial settlement development. Particularly, the study delves into the crucial Archaic period (6th – 4th BC), when several Latial towns underwent fundamental changes in terms of political organization, economic exchange, and urban planning. To shed light on the shifting fortunes of the Satrican community during this era, the rich ceramic record unearthed during decades of extensive archaeological fieldwork takes center stage.Challenging conventional views, the thesis explores the intricate relationship between ceramic standardization and craft systems during the Archaic period. It argues for a nuanced understanding of the material culture produced, beyond a simplistic correlation between standardization and societal progress. The research methodology integrates typo-morphological inquiries with materials science analyses to assess variability within ceramic assemblages.The analysis focuses on household ware pottery, storage containers, and building materials, providing insights into pottery production, distribution, and consumption systems in Satricum. By examining metric data and fabric characterization, the study elucidates the technological and morphological uniformity/diversity within ceramic artifacts. Petrographic studies further deepen understanding by exploring geological contexts and clay sources contributing to ceramic compositions.Ultimately, the dissertation contributes to the broader discourse on pottery studies, offering a comprehensive evaluation of pottery manufacturing systems in Archaic Satricum. It not only reassesses the debated link between specialization and standardization but also proposes future research avenues for a more holistic approach to understanding ancient material culture
Imaging in patients suspected of non-traumatic pulmonary disease at the emergency department:Chest X-ray or ultra-low-dose CT
Get PDFThe primary aim of this thesis was to study the impact on patient outcomes of replacing CXR by ultra-low-dose chest CT (ULDCT) in patients suspected of non-traumatic pulmonary disease at the emergency department (ED). This was a multicentre, pragmatic, non-inferiority randomised controlled trial (RCT) comparing ULDCT to CXR in consecutive. During randomly assigned periods of one calendar month, ULDCT or CXR was used as the imaging strategy. Between January 31, 2017, and May 31, 2018, 2418 consecutive patients (ULDCT: 1208, CXR: 1210) were included. We found a small but significant difference in the primary outcome measure functional health at 28 days: PCS score was 37.0 in the ULDCT group compared to 35.9 in the CXR group, a difference of 1.1 points (95% lower CI: 0.003). There were minimal differences in ED length of stay, hospital admissions, hospital length of stay, mental health, and mortality rates. After ULDCT significantly less additional imaging was done: ULDCT 39.3% versus CXR 53.9% of patients. More ULDCT patients were in follow-up after 28 days because of incidental findings: ULDCT 2.2% versus CXR 0.3%.CAP was more often diagnosed at ED discharge after ULDCT than after CXR (22.0% versus 16.4%), with subsequent confirmation of diagnosis at day 28 (ULDCT 19.4% versus CXR 14.7). Congestive heart failure was more often diagnosed with CXR at day 28 (ULDCT 5.7% versus CXR 9.6%). The results of our trial do not support the routine use of ULDCT in the work-up of patients presenting with non-traumatic pulmonary disease at the ED
Optimizing the preoperative selection of patients with ovarian cancer
Get PDFCommon methods used in the preoperative risk of malignancy assessment in patients with an ovarian mass perform suboptimal, leading to incorrect (non-)referral of patients to a specialized center. Serum biomarker human epididymis protein 4 (HE4) is considered as an alternative for the common used biomarker Cancer Antigen 125 (CA125). We observed that current literature on HE4 for this purpose was not performed in a population from general centers and therefore not reflecting the second line population in which a risk of malignancy assessment is relevant. In our study in a second-line population, we observed that HE4 was more cost-effective compared to common methods for the risk of malignancy assessment in patients with an ovarian mass from a second-line population. Additionally, circulating tumor DNA seemed to perform better compared to common methods as well. Besides the use of biomarkers in patients with an ovarian mass, we also investigated their usefulness in predicting surgical outcome in patients with advanced-stage ovarian cancer who have an indication for cytoreductive surgery. We observed that HE4 as part of a non-invasive model predicted well the successful surgery (less than 1 cm residual disease) in patients who underwent interval cytoreductive surgery. Diagnostic laparoscopy can also be considered as an invasive ‘’biomarker’’. Although a randomized controlled trial showed that the diagnostic laparoscopy can be useful in guiding primary treatment in patients with advanced-stage ovarian cancer, we observed that Dutch gynecologic-oncologists do not support routine implementation in clinical practice. Main reasons were centralization of care leading to a better preoperative selection and the availability of non-invasive alternative diagnostics
A Computational Framework for Modelling Biomechanical Tumour Dynamics and Tissue Interactions: A Proof-of-Concept in Pleural Mesothelioma
No full textIn Malignant Pleural Mesothelioma (MPM), solid stress and tissue deformation significantly impact tumour growth and invasion. This study presents a computational framework that integrates biomechanical tumour dynamics, tissue deformation, and force interactions within a realistic anatomical setting. Using the Finite Element Method, the framework is applied to a lung mesh reconstructed from CT scans, incorporating a synthetic mesothelioma tumour with defined material properties. Numerical results from the simulations closely match the analytical solution, with deviations within 5%, confirming the model’s reliability and accuracy. Simulations of point compression and surface expansion effectively capture the localised tumour deformation and lung volume changes, replicating expected breathing mechanics under different conditions. The findings emphasize the role of mechanical interactions in tumour progression, demonstrating how increased tissue stiffness affects deformation patterns and respiratory dynamics. This study establishes a foundation for integrating computational biomechanics with predictive tumour modelling, offering potential applications in personalised medicine for MPM
New insights into the management of ulcerative colitis
Get PDFDit proefschrift onderzoekt de rol van chirurgische interventies, in het bijzonder appendectomie, bij de behandeling van colitis ulcerosa (CU). De studies zijn geplaatst in de context van (geavanceerde) medicamenteuze therapieën en de impact daarvan op colorectale kanker (CRC) bij geopereerde patiënten.In deel I wordt de effectiviteit van biologicals en small molecules samengevat in een systematische review en meta-analyse. Deze therapieën bleken effectief voor zowel inductie (+13.1%) als onderhoud (+21.1%) van remissie en vormen daarmee een referentiekader voor chirurgische interventies.Deel II beschrijft de ACCURE-trial, de eerste gerandomiseerde studie naar laparoscopische appendectomie bij CU-patiënten in remissie. Appendectomie verlaagde het risico op opvlammingen significant (36% versus 56%). Voorspellende factoren voor gunstig effect waren jongere leeftijd en een rookverleden. Histopathologisch werd bij meer dan de helft van de patiënten inflammatie in de appendix vastgesteld, wat geassocieerd leek met een verhoogd risico op opvlammingen.In deel III wordt de effectiviteit van appendectomie onderzocht bij patiënten met actieve CU na falen van biologicals (COSTA-studie). Appendectomie was hierin superieur aan Janus kinase-remmers (32.8% versus 12.2% remissie zonder therapiefalen na 12 maanden). Intestinale echografie en histologische kenmerken waren potentieel waardevol voor patiëntselectie.Deel IV laat zien dat, ondanks het toegenomen gebruik van geavanceerde therapieën, de tijd tot colectomie onveranderd bleef, terwijl vaker incidentele carcinomen werden gevonden met slechtere CRC-gerelateerde overleving.Concluderend toont dit proefschrift dat appendectomie klinisch relevante voordelen kan bieden bij geselecteerde CU-patiënten
Uncertainties in Modeling Psychological Symptom Networks:The Case of Suicide
No full text In psychological research, network models are widely used to study symptoms of mental health disorders. However, these models often fail to account for uncertainty, leading to potentially misleading inferences. To address this issue, this study examines the robustness of psychological networks by analyzing a dataset of risk factors for suicidal behavior with multiple network algorithms. We compare two causal discovery algorithms—Hill Climbing (HC) and TABU search—and the Gaussian Graphical Model (GGM), a widely used statistical network model in psychology. Uncertainty is assessed along two dimensions: (1) the impact of noise, by introducing varying levels of white noise into the dataset, and (2) the effect of sample size reduction, by systematically decreasing the number of observations. Our results indicate that both HC and TABU search are highly sensitive to noise and sample size, with HC slightly outperforming TABU in terms of precision and recall. GGM performance declines gradually with increasing noise and sample size reduction, leading to sparser networks. For all algorithms, recall declined at a faster rate than precision. Finally, we examine the robustness of edges leading to suicidal ideation, finding that the edge from Depression to suicidal ideation remains relatively stable across conditions. This is a promising result, since many suicide interventions are based on treating depressive mood. Our results emphasize the importance of considering uncertainty in network-based psychological research, particularly when applying causal discovery algorithms.</p
Global Sensitivity Analysis for a Mathematical Model of the General Escape Theory of Suicide
No full textThis study explores a formalized dynamical systems model of the General Escape Theory of Suicide using Sobol and PAWN global sensitivity analyses. The findings highlight the importance of self-feedback loops, the effect of stressors on aversive internal states, and the interaction effects between aversive internal states and the urge to escape on suicidal ideation and non-suicidal escape behaviors. Time-dependent sensitivity analysis also reveals the long-term stability of parameter importance over time. These results hold potential for informing clinical interventions by identifying the most important influences for individual suicidal ideation.</p