EUR Research Repository
Not a member yet
514614 research outputs found
Sort by
Epidemiology and outcomes of children admitted to the pediatric intensive care unit in Suriname:a retrospective observational study from a middle-income country
No full textThe pediatric intensive care unit (PICU) at the Academic Hospital Paramaribo (AHP), operational since 2017, is the only tertiary referral center for critically ill children in Suriname. This study aims to describe the clinical and demographic characteristics and outcomes of critically ill children treated in the PICU over 2years, and to assess risk factors associated with mortality during PICU admission. A retrospective study of admissions from children 16years and younger admitted to the PICU of the AHP between January 1, 2021, and December 31, 2022. During the study period, 424 PICU admissions were included, of which 91% were acute and unplanned. The most frequent medical reasons for admission were convulsions (8.5%), pneumonia/lung abscess/empyema (7.5%), and bronchiolitis (7.3%). One hundred thirty-six admissions (32.0%) received mechanical ventilation, and 104 (24.5%) required inotropes. The median PICU stay was 3days (interquartile range 0–6), with a mortality rate of 12.0%. In the multivariate analysis, only male gender, mechanical ventilation, and inotropes were associated with increased risk of death. The results of this benchmarking study can ultimately serve as a valuable resource for policy-makers and important stakeholders in the process of improving the care provided to critically ill children in Suriname.</p
Bisphosphonates use is associated with increased coronary artery calcification in the general population:The Rotterdam study
No full textAims: Bisphosphonates may influence arterial calcification through mechanisms shared with bone formation. As treatment often extends over several years, assessing the arterial effects requires long-term follow-up. This population-based cohort estimated the long-term association of bisphosphonates with calcification across multiple key arterial sites. Methods: We included 2399 Rotterdam Study participants with baseline CT-assessed calcification in the coronary arteries (CAC), aortic arch (AAC), and extra/intracranial carotid arteries (ECAC and ICAC). Among these, 815 participants underwent repeat CT after a mean of 13.6 years. Pharmacy-linked data provided cumulative information on bisphosphonate use from study entry to follow-up. Multivariable linear and mixed-effects regressions evaluated associations between bisphosphonate use, duration, and the dose-response of duration with calcification volume. Results: Long-term bisphosphonate use (>5 years) was statistically significantly associated with larger baseline CAC compared with both never use (β [95 % CI]: 0.42 [0.10, 0.73]) and short-term use (p-interaction = 0.02). At follow-up, prolonged use (mean duration: 4.9 years) was also significantly associated with increased CAC. Effect estimates increased across quartiles of duration for CAC, AAC, and ECAC (but not ICAC), with a significant linear trend only for CAC (p-trend < 0.0001), suggesting a dose-response relationship. Across arterial sites, CAC showed the largest effect estimates, ICAC the smallest. Conclusions: Long-term bisphosphonate use is associated with increased arterial calcification, most notably with increased CAC, with a dose-response relationship further strengthening this observation. Large-scale observational studies are encouraged to use advanced causal inference methods to evaluate this long-term association and provide additional evidence to strengthen the causal interpretation.</p
Normothermic versus hypothermic machine perfusion in kidney transplantation:A randomized controlled trial
No full textHypothermic machine perfusion (HMP) is considered the gold standard in kidney preservation. Despite this, grafts from extended criteria donor-donation after brain death, and donation after circulatory death, remain at high risk of delayed graft function. Normothermic machine perfusion (NMP) during the preservation process could alternatively preserve physiological activity. We investigated the value of additional NMP to HMP in extended criteria donor-donation after brain death and donation after circulatory death kidney transplantation. This is a single-center, open-label, superiority, randomized controlled trial. Patients were randomized to receive a kidney that was either preserved on HMP and 2 hours of end-ischemic HMP + NMP (intervention group) or HMP only (control group). The primary outcome was the incidence of immediate graft function. A total of 80 patients were included in the intention-to-treat analysis, of which 41 received a kidney that was preserved on HMP and HMP + NMP, and 39 received a graft that was preserved on HMP alone. Incidence of immediate graft function was 39% (16/41) in the HMP + NMP group compared with 49% (19/39) in the HMP group, with no significant difference between both groups (odds ratio, 0.68; 95% confidence interval, 0.28-1.64; P = .38). There was no statistically significant difference in any of the secondary outcomes. The addition of 2 hours of end-ischemic NMP does not improve early graft outcomes in kidney transplantation compared with HMP alone.</p
LV Mass in Children With Extremely Low Birth Weight Is Lower But More Sensitive to Increased Blood Pressure
No full textBACKGROUND: Epidemiological evidence suggests higher rates of heart failure in adults born at an extremely low birth weight (ELBW). Reports on the echocardiographic phenotype in this population are inconsistent and do not consider the effect of modifiable contributors such as blood pressure. METHODS: This study reports on the echocardiographic findings of the PREMATurity as predictor of children's Cardiovascular-renal Health (PREMATCH) study, a prospective case-control study evaluating renal and cardiovascular outcomes in children with ELBW in comparison to term-born controls. Left ventricular (LV) mass was the primary outcome. Data were analyzed with multivariable-adjusted regression models considering anthropometric variables and systolic blood pressure as covariates. RESULTS: Eighty cases (median age, 10.8 years) and 72 controls (median age, 11.4 years) were included. Multivariable-adjusted analyses revealed that the adjusted difference in LV mass in cases versus controls was -8.49 g (CI, -13.78 to -3.20; P=0.002). Sex, height, weight, and body fat percentage were significant covariates. There was a positive interaction between ELBW status and systolic blood pressure (Pinteraction=0.039). There was a -6.47 g (CI, -11.7 to 1.28; P=0.016) difference in LV mass between normotensive cases and controls, while the difference disappeared between subjects with increased blood pressure or hypertension. CONCLUSIONS: ELBW children exhibit lower LV mass during childhood in comparison with term-born controls. However, elevations in systolic blood pressure are associated with a steeper increase in LV mass in cases than in controls. Our findings question whether cutoffs for the general population are adequate to evaluate and manage hypertension and LV hypertrophy in children with ELBW.</p
Posterior sentinel sign of the biceps tendon as an arthroscopic indicator of supraspinatus tears
No full textIntroduction: Magnetic resonance imaging (MRI) is highly accurate for diagnosing full-thickness rotator cuff tears but inaccurate in detecting small anterosuperior cuff tears near the rotator interval. Expanding on the concepts of long head of biceps tendon (LHBT) instability and the anterior sentinel sign, the present study evaluated the posterior sentinel sign, a novel arthroscopic indicator of supraspinatus tears. Methods: This monocentric prospective cohort study included patients undergoing arthroscopic repair of rotator cuff tears at a single institution. The integrity and stability of the LHBT were assessed intra-articularly for abrasion, delamination, or partial tears. Sentinel signs were classified as anterior or posterior based on their location on the LHBT. Rotator cuff tears were evaluated, and their correlation with sentinel signs was analyzed using the chi–squared test. To evaluate the diagnostic value of the sentinel signs, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated. Results: This study included 69 patients. The posterior sentinel sign was observed in 21/39 patients with supraspinatus tears (53.8%) and in 1/30 patient without (3.3%), showing a significant association (X2 = 19.9, p < 0.001, Phi = 0.54). For detecting supraspinatus tears, the posterior sentinel sign had a sensitivity of 53.8% (95%CI: 38.6–68.4), specificity of 96.7% (83.3%-99.4), PPV of 95.5% (78.2–99.2), NPV of 61.7% (47.4%-74.2) and AUC of 0.79 (95%CI: 0.68–0.89). The anterior sentinel sign was present in 17/24 patients with subscapularis tears (70.8%) and absent in those without (0/45), showing a significant association (X2 = 42.3, p < 0.001, Phi = 0.78). For detecting subscapularis tears, it had a sensitivity of 70.8% (95%CI: 50.8–85.1), specificity of 100% (92.1–100), PPV of 100% (81.6–100), NPV of 86.5% (74.7–93.3) and AUC of 0.97 (95%CI: 0.87–0.99). Conclusions: Expanding our evaluation of the previously reported arthroscopic LHBT sentinel sign with a more detailed description of location, two main types can be discriminated. The anterior sentinel sign, which is associated with subscapularis tears, and the posterior sentinel sign, which is associated with supraspinatus tears. The presence of a sentinel sign should prompt the clinician tosearch for (occult) anterosuperior rotator cuff tears. Level of evidence: Level III.</p
On the modeling of the Olivocerebellar system
No full textThe cerebellum helps us learn and refine movements, from simple actions like reaching to more complex skills such as playing the violin. Although its structure is highly organized, many details about how it supports stable and flexible learning are still unknown. This thesis investigates how different parts of the cerebellum work together to keep learning both accurate and stable over time.A central focus is the communication between Purkinje cells (the main processing units of the cerebellar cortex) and the inferior olive, a brainstem structure that sends timing signals known as “complex spikes.” These signals help the cerebellum decide when to strengthen or weaken connections, allowing it to correct errors and adapt to new conditions. Using computational models, this thesis explores how two types of cerebellar modules, called “upbound” and “downbound,” learn in different ways. These modules have distinct electrical properties and favor different forms of synaptic plasticity. The results show that these differences allow the cerebellum to learn multiple things at once, each at its own pace and with its own rules. The thesis also introduces a new idea: that a single cerebellar module can combine both open-loop and closed-loop control. This means part of the circuit can learn from feedback while another part can monitor internal changes without affecting the output. Overall, the work shows how the cerebellum balances flexibility and stability during learning. This modular organization may help explain how the cerebellum supports not only movement but also higher cognitive functions.<br/
Zuiveringsheffing naar drie vervuilingseenheden. Discriminatie van tweepersoonshuishoudens
No full textIoNE kwalificeert voor toepassing Verdrag Nederland-Brazilië als dividend
No full textDe crux met de IoNE zit hem in het feit dat het Verdrag Nederland-Brazilië dateert uit 1990 en de IoNE in 1995 in de Braziliaanse belastingwet is opgenomen. De vraag rijst of IoNE als dividend of interest moet worden gekwalificeerd voor genoemd verdrag. Dit is niet geheel zonder belang want het Verdrag Nederland-Brazilië bevat een tax sparing credit van 25% voor dividenden en 20% voor interest
Relational governance processes in social entrepreneurship ecosystems:the role of social capital
No full textPurpose – Social entrepreneurship ecosystems (SEEs) are communities of varied yet interdependent actors collaborating to impact the environment for social entrepreneurs. To date, there is limited understanding of the processes that drive their functioning. The purpose of this paper is to address this limitation by explaining how SEE relational governance processes strengthen relationships among actors. Design/methodology/approach – This conceptual paper uses narrative theorizing to integrate ecosystem research with social enterprise literature and proposes an SEE relational governance process. Grounded in social capital theory, the authors explain how networks, norms and trust enhance relationships within SEEs. Findings – The authors identify how diverse ecosystem actors shape governance processes in SEEs: Socializing fosters collaboration within the network; Strategizing aligns objectives through shared norms; and Legitimizing reinforces trust via transparent communication. Research limitations/implications – This paper advances the theoretical understanding of SEE by linking ecosystem governance with social enterprises and social capital theory. The process offers insights into the role of networks, norms and trust in shaping relational ecosystem governance. Practical implications – By articulating SEE relational governance, the authors give ecosystem builders, policymakers and support intermediaries a concrete checklist: expand and broker ties; co-create objectives that match those ties; and signal progress through shared impact metrics and credible partnerships. Originality/value – This paper advances SEE research by offering a process-oriented approach for SEE relational governance. The authors identify Socializing, Strategizing and Legitimizing as the three interconnected processes through which ecosystem actors connect, align objectives and build trust.</p