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Blowing Minds:A cross-cultural, longitudinal investigation to unravel the highs and lows of recreational and medicinal cannabis users
No full textCannabis use is widely on the rise for recreational and medicinal purposes, with the latter often aimed at improving mental health and cognition. Simultaneously, the prevalence of cannabis-related health harms, such as cannabis use disorder (CUD), is increasing. Product potency, route of administration, and preexisting mental health symptoms play a role in the effects of cannabis; however, there is limited research on how broader factors, such as local cannabis legislation and perceptions of use, may influence these outcomes. Moreover, knowledge remains sparse regarding the growing population of medicinal users, predominantly using without medical supervision. Altogether, this illustrates the need for ecologically valid ways to investigate individuals and their cannabis usage within real-world settings. Therefore, this longitudinal, cross-cultural online study examines an international sample of regular recreational and medicinal users (aged 18–65) from different cannabis jurisdictions (e.g., the Netherlands, the United States, Brazil, Canada, and regions in Asia and Africa) in their natural environment via their mobile phone. By using the Experience Sampling Method (ESM), alongside a comprehensive battery of cognition and mental health related assessments over a 2-year period, we aim to gain insight into the short- and long-term mental health and cognitive determinants and consequences of cannabis use, and how these interact with broader, contextual factors, such as legislation. This is one of the first cross-cultural studies assessing both positive and negative effects of cannabis longitudinally, examining the full range of effects that cannabis may have on the individual.</p
Medical psychiatry units:Standardization versus variaton
No full textThis thesis aims to provide insight into what an MPU can look like, how to decidewhich patients should be admitted to an MPU, and how to measure the quality ofan MPU. These aims translate into 3 research questions:Question 1: What characterizes the geographical spread, organizational structure,and quality of contemporary MPUs in the Netherlands and the United States?This question is answered in Chapter 2 and Chapter 3. Chapter 2 is titled MedicalPsychiatric Units in the Netherlands: an investigation into distribution and quality.Chapter 3 is titled Variation in structural characteristics among twenty Medical PsychiatryUnits in the United States: a survey-based study.Question 2: What patient, staff, and organizational factors are pivotal in the decision-making process regarding admissions to MPUs?Chapters 4 and 5 answer this question. Chapter 4 is titled Need analysis for a newhigh acuity Medical Psychiatry Unit: which patients are considered for admission?Chapter 5 is titled Factors influencing the admission decision for Medical PsychiatryUnits: a concept mapping approach.Question 3: How is the quality of care within general hospital psychiatry perceivedand defined by patients, healthcare professionals, and funding entities?This question is answered in Chapter 6: Identifying value-based quality indicatorsfor general hospital psychiatry.<br/
Low back pain with radiating leg pain in primary care:Epidemiology, management and prognosis
No full textThis thesis investigates the epidemiology, management, and prognosis of low back pain with radiating leg pain in primary care. Radiating leg pain, which can be classified as either somatic (referred) or radicular (nerve-related), is a common and often more debilitating condition than localized back pain. Through a systematic review of international clinical practice guidelines, this research highlights a consensus on the diagnostic importance of physical examinations and a cautious approach toward routine imaging. However, the study also identifies significant inconsistencies across global guidelines regarding pharmacological treatments, particularly concerning the effectiveness and recommendation of specific painkillers.The research further explores the clinical course and prognostic factors of back pain with radiating leg pain in older patients (aged 55 and older) through the BACE cohort study. Findings indicate that the distal extent of radiation—specifically pain reaching below the knee—is associated with higher pain intensity, greater disability, and a higher psychological burden, including kinesiophobia and depressive symptoms. While most patients experience significant improvement within the first three months after visiting a general practitioner, several factors such as smoking, poor self-rated health, and psychological distress were identified as predictors of a poorer long-term recovery after one year.Finally, the thesis examines the real-world management of these patients within the Dutch healthcare system and evaluates the effectiveness of structured exercise programs. Analysis of large-scale primary care data in the Rijnmond region confirms that Dutch GPs generally adhere to guidelines by limiting MRI referrals, though medication prescription remains high. Additionally, the study demonstrates that a structured education and exercise intervention (GLA:D Back) is equally effective for patients with radiating leg pain as it is for those with localized back pain. These results emphasize the need for a biopsychosocial approach in primary care to better support patients at risk of chronic complaints.<br/
Undergraduate students’ perceptions of generative artificial intelligence as a predictor of learning autonomy in Ghana
No full textThe rapid adoption of generative artificial intelligence (GenAI) in higher education raises important questions about students’ preparedness to use these tools meaningfully, particularly in low-resource contexts where digital access and AI literacy remain limited. This study examined whether undergraduates’ perceptions of GenAI use predict learning autonomy in a Ghanaian higher education setting (N = 969). A cross-sectional survey revealed that more than half of the students reported no prior experience with AI tools, and nearly one out of three had low AI literacy levels. Grounded in Self-Determination Theory (SDT), the data analysis applied descriptive statistics, Pearson’s correlation, and linear regression. Findings demonstrated a strong positive relationship between GenAI perception and learning autonomy, with GenAI perception accounting for 75.8% of the variance in autonomy. While this effect size is unusually high and should be interpreted with caution, the study provides actionable insights for designing educational strategies that equip students with the skills to engage responsibly and effectively with AI tools, thereby fostering autonomy and preparing them for a digitally evolving academic environment.</p
From evidence to impact:The use of scientific research in policy documents
No full textWe examine the use of scientific research in the development of policy documents within the context of clinical practice guidelines (CPGs) for diagnosing, treating, and managing diabetes. Using natural language processing, we identify “hidden citations” (i.e., textual credit without formal citations) and “token citations” (i.e., formal citations without textual credit) to scientific research within CPGs to understand how scientific evidence is selected and integrated. We find that both types of citations are pervasive, calling into question the use of formal citations alone in understanding the societal impact of scientific research. Using data on scholarly citations and expert ratings, we find that hidden citations are positively associated with the actual impact of the research on patients and caregivers while token citations associate positively with scientific impact. Qualitative insights gathered from interviews with senior guideline writers further illustrate the reasons for certain functions of scientific research, which involve balancing scientific rigor with practical demands in the guideline writing process, the need for local adaptations, political dynamics on the organizational level, and individual preferences towards certain types of studies or the use of experiential knowledge. Our work underscores the critical role of research utilization in translating scientific evidence into policy, showing that policymaker decisions shape societal impact as much as the engagement efforts of scientists, and extends institutional accounts of symbolic and substantive knowledge use.</p
Development and preliminary validation of a novel chest wall specific quality of life instrument-C-QoL
No full textBACKGROUND: Quality of Life (QoL) is a core metric for patients with chest wall injury (CWI). No thoracic specific QoL instruments exist and granularity to assess impact of interventions on patients with chest wall injury is lacking. We hypothesized we could develop a valid and reliable CWI specific quality of life (C-QoL) questionnaire.METHODS:A systematic review of QoL instruments used in chest wall injury literature was performed and an international group of CWI experts assembled a panel of questions for inclusion. A three-round modified Delphi consensus process was performed using a 70% consensus threshold. A clinical validation study enrolling adults with ≥1 rib fractures(s) was performed. Participants completed the C-QoL and the SF-36 twice, with a week intervening each response. Reliability, construct validity, floor and ceiling effects of the C-QoL (sub)scales were determined using the COnsensus-based Standards for the selection of health Measurement Instruments group guidelines.RESULTS: Twenty-two CWI experts participated in the Delphi process resulting in creation of the C-QoL instrument with five domains: pain, physical functioning, general health, socio-economic functioning, and psychological health. Scores ranges from 0 to 100. Median QoL score for the first 154 participants was 34 (P25-P75 25-50). Subscale scores ranged from 29 (P25-P75 14-48) for pain to 55 (P25-P75 37-75) for psychological health. All (sub)scales showed an inverse correlation with injury severity and had adequate reliability (Cronbach alpha between 0.70 and 0.95), construct validity (>75% or correlations with SF-36 (sub)scales are predicted correctly) and had no floor or ceiling effect. CONCLUSION: The C-QoL instrument is reliable and valid for measuring CWI specific QoL in patients. A prospective study is needed to externally validate the instrument, and to determine the responsiveness, measurement error, and minimal important change. LEVEL OF EVIDENCE: Diagnostic Tests or Criteria; Level II.</p
Emergence, spread, and impact of high-pathogenicity avian influenza H5 in wild birds and mammals of South America and Antarctica
No full textThe currently circulating high-pathogenicity avian influenza (HPAI) virus of the subtype H5 causes variable illness and death in wild and domestic birds and mammals, as well as in humans. This virus evolved from the Goose/Guangdong lineage of the HPAI H5 virus, which emerged in commercial poultry in China in 1996, spilled over into wild birds, and spread through Asia, Europe, Africa, and North America by 2021. Our objective was to summarize the spread and impact of the HPAI H5 virus in wild birds and mammals in South America, evaluate the risk of its spread and potential impact on Antarctic wildlife, and consider actions to manage the current and future HPAI outbreaks in wildlife. We obtained data on HPAI H5 virus detection and reported wildlife deaths from websites, newspaper articles, and scientific publications. The virus arrived in South America in October 2022. Thereafter, it spread widely and rapidly throughout the continent, where it infected at least 83 wild bird species and 11 wild mammal species and is estimated to have killed at least 667,000 wild birds and 52,000 wild mammals. The HPAI H5 virus spread to the Antarctic region by October 2023 and to mainland Antarctica by December 2023. This spread was associated with multiple mortality events in seabirds and marine mammals. The high spatial density of colonies of various Antarctic species of birds and mammals provides conditions for potentially devastating outbreaks with severe conservation implications. Ecosystem-level impacts may follow, and affected populations may take decades to recover. Although little can be done to stop the virus spread in wildlife, it is important to continue targeted surveillance of wildlife populations for HPAI H5 virus incursion and assessment of the spread and impact of disease to inform adaptation of conservation plans and to help policy makers mitigate and prevent future HPAI outbreaks.</p
Deformable lung models for anatomical lung resections:The introduction of simulated reality for imaging guidance
No full textObjective:This study introduces PulmoSimulatedReality (Pulmo-SR), a novel technique combining artificial intelligence, finite element method, 3-dimensional (3D) visualization, and 4-dimensional (4D) interaction for preoperative imaging and intraoperative surgical guidance in pulmonary resections, such as lobectomy and segmentectomy. The clinical applicability of this 3D modeling approach is evaluated through a preliminary validation protocol.Methods:A deep learning algorithm was employed to generate 3D segmentations of patient anatomy. 3D models were created for 30 patients undergoing pulmonary resection, and 4D models were developed using the Pulmo-SR platform, incorporating finite element methods for dynamic deformation. Clinical validation was conducted by assessing accuracy, precision, and sensitivity using retrospective intraoperative video recordings alongside dynamic 4D models. Latency and 3D model reconstruction time were also measured. Results:Validation of 30 cases yielded high average scores for accuracy, precision, and sensitivity, respectively: artery (0.987 ± 0.047, 0.993 ± 0.037, and 0.994 ± 0.031), vein (0.976 ± 0.099, 0.976 ± 0.099, and 1.00 ± 0.00), and bronchus (1.00 ± 0.00, 1.00 ± 0.00, and 1.00 ± 0.00). Latency was 0.23 ± 0.06 seconds, and 4D model reconstruction was completed in 8.47 seconds. Conclusions:Pulmo-SR integrates artificial intelligence, finite element method, and 3D modeling to provide a 4D deformable reconstruction of patient anatomy, offering realistic simulations for complex lung resections. Clinical validation demonstrated high accuracy, precision, and sensitivity, indicating the potential as a valuable tool in preoperative and intraoperative workflows for anatomical lung resections.</p