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The People versus Behavioral Science:Alignment between lay and scientific understanding of compliance
No full textSince the beginning of the 21st century, behavioral insights have increasingly been used to inform policy. However, rather than land in a vacuum, such insights arrive in a setting where the citizens they target themselves have lay understanding of what shapes behavior-an understanding that may critically shape their endorsement of such policies. As such, to change behavior through behavioral science, people's lay understanding is of pivotal importance. Yet so far, we know little about how laypersons think about changing behavior, or whether their lay understanding of this aligns with that of science. The present research examines this question by focusing on rule compliance, a frequent target of behavioral influence. In a large-scale survey (N = 3326), we assess participants' lay perceptions of how compliance is shaped by different mechanisms identified in the academic literature, and compare this to empirically observed associations. For this purpose, we focused on behavioral measures against COVID-19-newly introduced rules that applied universally, where behavioral insights were widely utilized to promote compliance, and ample empirical data exists on relevant mechanisms. Our findings revealed that at the aggregate level, there was substantial concordance between participants' lay understanding of how different mechanisms contributed to compliance and empirical evidence-although participants seem to overestimate their impact in absolute terms, and underestimate their variability. While this result need not imply that laypersons individually have an accurate understanding of what shapes compliance, it does suggest that collectively, people's lay understanding of these processes was broadly aligned with a scientific understanding. Moreover, their lay understanding of these processes was associated with their preferences for policies to shape compliance by leveraging these mechanisms. In this way, people's lay understanding may provide a stepping stone for scientifically informed policies-and an important reservoir of experiential knowledge that the science of behavior change can tap into.</p
Progress in Employee Participation?:A Critical Analysis of Board-level Employee Representation in China’s New Company Law
No full textBoard-level employee representation (BLER) is a practice in company law that allows employees to elect representatives to the board of directors and the supervisory board (i.e. employee directors and employee supervisors, respectively) so that employees can participate in corporate governance. China’s Company Law, adopted on 29 December 2023 (the 2023 Company Law), introduces significant changes to BLER. This article traces the evolution of BLER in China and explains the rationale for promoting employee directors in the 2023 Company Law. The revised law encourages the inclusion of employee directors across all company types. Although the 2023 Company Law indicates progress over earlier versions of company laws, significant limitations persist. Employee supervisors face obstacles to discharging their duties; the proportion of employee directors required on the board of directors is unspecified; and the law lacks specific provisions for the qualifications of employee representatives, their competence to perform their functions, and their professional safeguards. In other words, the 2023 Company Law may not substantially enhance BLER.</p
Trans-immanence, morphogenesis and régulation:new methodological avenues for applied political economy (of education) research
No full textThis article aims to illustrate an application of Knio's Morphogenetic Régulation (MR) in education policy scholarship. In doing so, I am particularly interested in revisiting and unpacking the broader reasoning that underpins this framework in order to demonstrate its analytical strength and practical value for applied research. Accordingly, I discuss the roots of MR in Archer's Morphogenetic Approach (MA) and its subsequent refinement through a Spinozian notion of immanent causality and methodological tenets from the French Régulation tradition in political economy, highlighting the implications of these analytical enhancements for the work of social researchers. Among the various ontological innovations introduced by MR, I emphasize how it reinserts the causal role of ideas - always embedded in material conditions - into morphogenetic thinking to elucidate how agents' reflexivity across moments of social interaction creates an opportunity, largely overlooked in the original MA, to address retroductive (or causal) questions in social inquiry.</p
Peri-conceptional maternal vulnerability risk score and embryonic growth:the Rotterdam Periconception Cohort
No full textResearch question: What is the association of peri-conceptional maternal vulnerability, assessed through a weighted multi-domain risk score with embryonic growth? Design: 638 pregnancies were included from the Rotterdam Periconception Cohort. Data on nine vulnerability factors (encompassing lifestyle, mental health and environmental factors) were obtained through self-administered questionnaires. The Periconceptional Vulnerability Risk Score (PVRS) was calculated using weighted estimates of associations between vulnerability factors and ‘Big 3’ pregnancy outcomes (congenital anomalies, preterm birth and small for gestational age). Embryonic growth was assessed by repeated first-trimester 3D transvaginal ultrasound measurements of crown-rump length and embyronic volume, analyzed with VR-software. Results: For the total study population, the PVRS ranged from –0.071 to 0.320 (median 0.131). Higher PVRS values were significantly associated with reduced embryonic growth trajectories (CRL: β = –0.58 mm, 95% CI –0.94 to –0.23, P = 0.001; embryonic volume: β = –0.31 cm³, 95% CI –0.49 to –0.13, P = 0.001). Subgroup analyses revealed significant negative associations in naturally conceived pregnancies (CRL: β = –0.82 mm, 95% CI –1.48 to –0.16, P = 0.015; embryonic volume: β = –0.39 cm³, 95% CI –0.71 to –0.08, P = 0.015) and in overweight women (CRL: β = –0.91 mm, 95% CI –1.55 to –0.27, P = 0.006; embryonic volume: β = –0.51 cm³, 95% CI –0.82 to –0.21, P = 0.001).Conclusions: The PVRS provides a weighted measure of maternal vulnerability, significantly associated with reduced embryonic growth, particularly in naturally conceived pregnancies and overweight women. Although no causality can be inferred from this study, the observed associations suggest that a broad peri-conceptional vulnerability assessment could help to identify potentially modifiable risk factors.</p
Outcomes for ER-positive CHEK2 c.1100delC breast cancer patients compared with breast cancer patients without the variant
No full textPurpose: Germline CHEK2 c.1100delC-associated breast cancer (BC) patients have been reported with worse prognosis than patients without the variant. However, results are based on older cohorts and treatment regimens. As part of the Hebon-CHEK2 study, we aim to study prognosis in a Dutch cohort of genetically tested ER-positive BC patients diagnosed from 2006 onwards. Methods: All patients underwent genetic testing based on personal and family history risk, and data on BC outcomes were collected. Hazard ratios (HRs) and 95 % confidence intervals (CI) for the association of CHEK2-status with prognosis were estimated via delayed entry Cox regression models, adjusted for age and year of diagnosis, tumor size, nodal status, and primary treatment regimens. Furthermore, we meta-analyzed our results with previous studies. Results: We included 480 CHEK2 BC patients and 944 BC patients without the variant. Median follow-up was 6.0 years. Heterozygotes were more often diagnosed with small tumors, and lymph node positive disease. No significant difference was found for recurrent disease and distant disease-free survival, neither before 5 years (HR = 0.73; 95 %CI = 0.35–1.53 and HR = 0.99; 95 %CI = 0.44–2.21, respectively), nor after 5 years follow-up (HR = 0.29; 95 %CI = 0.06–1.28 and HR = 0.39; 95 %CI = 0.10–1.39, respectively). Also no significant difference in BC-specific survival (HR = 0.77; 95 %CI = 0.42–1.39) or overall survival (HR = 0.69; 95 %CI = 0.43–1.08) was found. Meta-analysis of our results with previous studies showed a worse BC-specific survival for heterozygotes. Conclusion: In our study, with more recent years of diagnosis and treatment, we found no difference in prognosis, as opposed to previous studies. Further research is needed to validate our findings.</p
An Integrated proteomic workflow for body fluid classification and single amino acid variant identification:Advancing towards body fluid source attribution
No full textA particularly challenging subject in the investigation of forensic human biological traces is analyzing samples containing mixtures of body fluids from multiple donors. Ideally, researchers want to identify each type of body fluid present. However, traditional methods, like mRNA and DNA profiling, often struggle with sensitivity, specificity, and efficiency, especially in complex mixtures. This proof-of-concept study has two primary aims: first, to classify body fluids within a mixture using discriminatory protein markers, and second, to evaluate the feasibility of using single amino acid variants (SAAVs) to trace the source of specific body fluids back to individual donors. To achieve this, we employed proteomic analysis via liquid chromatography-tandem mass spectrometry (LC-MS/MS) in data-independent acquisition (DIA) mode, developing a reliable approach for accurate body fluid classification. Through comprehensive proteomic profiling, we characterized a diverse array of discriminatory proteins present in peripheral blood, semen, saliva, urine, and vaginal fluid. Using advanced data analysis techniques, including t-distributed stochastic neighbor embedding (t-SNE), we demonstrated that these proteins could reliably distinguish between different body fluids, even in mixed samples. Additionally, our findings reveal that SAAVs within certain proteins, such as those in saliva, hold promise for source attribution in a forensic context. Challenges, including contamination and limited sample sizes, highlighted the need for strict quality controls and further large-scale studies. With these improvements, proteomic analysis could greatly enhance body fluid identification, classification, and source attribution in forensic investigations, improving both accuracy and reliability in forensic science.</p
The Genitourinary Pathology Society and International Society of Urological Pathology Joint Expert Consultation Recommendations on intraductal carcinoma of the prostate
No full textConflicting practice recommendations regarding the grading of intraductal carcinoma of the prostate (IDCP) from two leading uropathology societies, the Genitourinary Pathology Society (GUPS) and the International Society of Urological Pathology (ISUP), are confusing for both pathologists and treating clinicians. The objectives of this consultation were to clarify unresolved issues regarding IDCP and atypical intraductal proliferation (AIP) terminology, diagnostic criteria, grading, and management implications, as well as to develop uniform reporting guidelines for IDCP and AIP, endorsed by both societies. A 32-member expert panel, composed of five core members, 25 expert urological pathologists, and two expert urologists, employed a modified Delphi process consisting of multiple rounds of consultation and voting. These were supplemented by discussions at the 2025 United States and Canadian Academy of Pathologists Annual Meeting to achieve expert consensus (defined as at least 67% agreement). Consensus was reached on several key issues. IDCP was regarded most commonly as reflecting the retrograde spread of invasive prostate cancer (PCa). IDCP diagnosis should be based on the Guo and Epstein criteria, supported by basal cell immunohistochemistry in cases that are difficult to distinguish from invasive PCa. The term AIP should be used only in equivocal proliferations where IDCP is favoured but the criteria are not fully met, and these should be reported as ‘AIP, suspicious for IDCP’. In the presence of invasive PCa, IDCP should generally be incorporated into Gleason grading irrespective of Grade Group (GG). However, a significant minority (30%) favoured excluding IDCP from the Gleason score if the invasive component was solely Gleason pattern (GP) 3. Pure IDCP (not associated with invasive PCa) and AIP, suspicious for IDCP, should not be graded. IDCP should not be incorporated in the grading of invasive PCa when it is spatially distinct from invasive PCa. A second opinion from a senior or dedicated GU pathologist and discussion within a multidisciplinary management setting should be considered, in the rare settings of pure IDCP or GP3 + IDCP (formerly GG1 + IDCP scenario). This joint GUPS–ISUP consultation provides unified recommendations for the diagnosis, terminology, grading, and reporting of IDCP and AIP, and will pave the way for the development of future IDCP/AIP WHO guidelines. Their adoption should reduce interobserver variation, facilitate consistent communication with clinicians, and improve patient management.</p
Lipid changes in females with familial hypercholesterolemia during the menopausal transition period
No full textBackground and aims:Familial hypercholesterolemia (FH) is a common inherited dyslipidemia, affecting 1 in 311 individuals. In females, lipid profile changes occur during the menopausal transition period, but there is limited research on how menopause affects lipids in females with FH. The aim of this study was to investigate changes in lipid levels and lipid-lowering therapy (LLT) in females with FH before and after menopause. Methods:We analyzed female patients with definite or probable FH (defined as Dutch Lipid Clinic Network score ≥6) from the British Columbia FH Registry with at least one lipid profile before and after self-reported age of menopause, or the age of 51 years if no self-reported date was available. We compared levels of low-density lipoprotein-cholesterol (LDL-C) and other lipids, as well as use of LLT at these two timepoints. Results:A total of 93 females with FH were included in the analyses, of which 33 self-reported age at menopause and 60 were estimated at 51 years. LDL-C levels increased by 0.78 mmol/L from pre-to post-menopause (p < .001), representing a 12 % increase, and by 1.05 mmol/L (p = .04), a 17 % increase, in untreated females. The increase in LDL-C was significantly greater in those with a monogenic FH-causing genetic variant compared to those without (1.23 mmol/L vs. 0.39 mmol/L, p = .02). There were also significant increases in the proportion of females treated (10.8 %) and in treatment potency during the menopause transition period, as well as in other lipids including total cholesterol, triglycerides and non-high-density lipoprotein cholesterol. Conclusion:LDL-C increases significantly during the menopausal transition period in females with FH, which contributes to an elevated cardiovascular risk post-menopause. These findings underscore the need for close monitoring and treatment of lipid levels during the menopausal transition in females with FH.<p/
AI in critical care:A roadmap to the future
No full textArtificial intelligence (AI) has the potential to revolutionize critical care medicine by enhancing patient care, improving resource allocation and reducing clinician workload. Despite this promise, many AI applications remain confined to scientific research rather than being integrated into everyday clinical practice. This manuscript aims to help intensivists prepare themselves and their intensive care units (ICUs) for AI implementation. It provides a comprehensive yet practical roadmap, detailing AI methods, applications, responsible AI principles, common roadblocks and implementation strategies. We propose a three-tiered risk-based approach to AI implementation, starting with low-risk low-complexity administrative AI, progressing to logistical AI, and finally integrating medical AI as clinical decision support systems. This ensures a gradual build-up of AI skills, technical AI readiness of the ICU, incremental value demonstration and alignment with evolving regulatory standards. For each AI project, responsible AI principles should be incorporated and adequately addressed throughout the entire AI lifecycle, from development to validation to implementation and scaling. Common roadblocks for AI implementation including technical issues (such as data quality and interoperability issues), organizational challenges (such as lack of a clear vision and strategy), and clinical concerns (such as limited AI literacy among staff), should be addressed proactively. By following this roadmap, ICUs can achieve sustainable AI integration, ultimately improving patient outcomes and clinician experience. The future of critical care lies in the responsible and strategic adoption of AI, with intensivists playing a central role in shaping its implementation.</p
Complications of microaxial flow pump and VA-ECMO in infarct-related cardiogenic shock:Insights from the Netherlands heart registration
No full textBackground: Active mechanical circulatory support (MCS) is associated with high complication rates. Reducing device-related complications may improve outcomes in patients with infarct-related cardiogenic shock (AMI-CS). This study aims to provide in-depth insight in the occurrence, specification and timing of complications in patients receiving active MCS, providing valuable starting points for clinical practice and future studies to reduce complications. Methods: This real-world, multicentre study, using data from the Netherlands Heart Registration PCI-Registry, describes AMI-CS patients that underwent PCI and received MCS between 2017 and 2021 across 9 Dutch hospitals. Results: This registry included 241 patients with a mean age of 59.7 years and predominantly male (78.0 %). Microaxial flow pump (MFP), VA-ECMO and MFP + VA-ECMO were used in 93 (38.6 %), 121 (50.2 %) and 27 (11.2 %) patients. MFP + VA-ECMO was associated with highest complication rates, particularly bleeding events (67 % vs. MFP: 33 % vs. VA-ECMO: 40 %). Differences in bleeding events persisted while accounting for competing risk of death (subdistribution hazard ratio (SHR) MFP + VA-ECMO vs. MFP: 2.33 [1.33–4.07]; SHR MFP + VA-ECMO vs. VA-ECMO: 2.00 [1.19–3.36]). SHR for VA-ECMO vs. MFP was 1.18 [0.74–1.90]). Bleeding events were observed within the first days of support, but also on the day of explant and thereafter. Access-site related bleeding events accounted for 51 % of all bleeding events. Conclusions: Combined use of MFP and VA-ECMO was associated with higher complication rates, particularly bleeding events, compared to single device use. Complication rates between MFP and VA-ECMO were not significantly different. Importantly, patients are still at risk for bleeding events during and after explant of MCS devices.</p