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Oncological outcomes of planned and unplanned low Hartmann's procedure and restorative low anterior resection for rectal cancer:a population-based cross-sectional study
No full textBACKGROUND: In the Netherlands, approximately 15% of patients with rectal cancer undergo a low Hartmann's procedure (low-HP). This is often preoperatively planned to avoid poor functional outcome or complications, but might be unplanned as a result of intraoperative difficulties. Low-HPs seem to be associated with worse oncological outcomes.METHODS: All patients who underwent either restorative low anterior resection (rLAR), planned low-HP, or unplanned low-HP for primary rectal cancer in 2016 were included from a nationwide cohort. Main outcomes were 4-year local recurrence (LR) rate and disease-free survival (DFS).RESULTS: Of 2043 patients, 1704 underwent rLAR (83.4%), 253 planned low-HP (12.4%), and 86 unplanned low-HP (4.2%). Among intended rLAR patients (n = 1790), independent risk factors for unplanned low-HP were older age, higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) score, and more distal tumor location. Oncological outcomes after low-HPs were worse than after rLARs (LR 13.7% vs 5.6%, DFS 54.7% vs 71.8%, both p < 0.001), but similar for unplanned and planned low-HP. In multivariable analysis, unplanned and planned low-HP were not associated with LR or DFS, but R1 resection was (HR 6.6 (4.1-10.6), HR 3.0 (2.2-4.0), respectively). In R1 resections, the distal margin was more often involved after low-HP (70.0% vs 28.6%, p = 0.013) compared to rLAR.CONCLUSION: Poor outcomes in univariable analysis after low-HP appear to be associated with more challenging procedures and increased risk of involved resection margin rather than the low-HP itself. In case of expected difficulties, an extralevator abdominoperineal excision or referral to an expert center might be an alternative to improve resection margins.TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT05539417, retrospectively registered on September 16, 2022.</p
When are leaders blamed for bad events that never happened? Partisanship and close counterfactual catastrophes
No full textHow much blame do leaders deserve for counterfactual catastrophes: disasters that could have occurred under their watch but never did? We propose that when people oppose (vs. support) a leader, they are more likely to answer this question by considering how close the catastrophe came to occurring. In two preregistered experiments (total N = 1927), U.S. participants assigned greater blame for counterfactual catastrophes (e.g., an imagined nuclear attack) to Presidents Trump and Biden when these catastrophes were framed as having been close to occurring rather than distant – but especially when judging the president they opposed (vs. supported). The results reveal a novel way in which counterfactual thinking facilitates partisan reasoning. Evaluating a leader they oppose may decrease people's focus on how a catastrophe never occurred and increase their focus on how it nearly occurred. We discuss how imagination can fuel political polarization
Multi-Stimulus Triggered Programmable Transformation of Molecular Motor Based Chiral Supramolecular Polymers in Water
No full textA notable characteristic of living organisms is their capacity to adapt to environmental changes and transform external signals into distinct responsiveness, facilitating the execution of diverse functions with motility as a key parameter. To better mimic such lifelike behavior, researchers have developed various supramolecular assembled systems with responsive behavior toward a variety of stimuli. However, exploiting motion along length scales and achieving collective control over the responsiveness to multiple stimuli in supramolecular systems is still challenging. Here we present the development of molecular motor based supramolecular polymers that are responsive toward multi-stimulus and exhibit multi-state assembly and chirality. Taking advantages of aldehyde functionalized motors, we realized photo-responsive supramolecular polymers featuring boosted photo-efficiency, near quantitative photoconversions, programmable behavior and responsiveness to multiple stimuli in a reversible manner in aqueous media. The various stimuli including light and different chemicals could act on the motor building blocks and subsequently trigger the transformation of the supramolecular polymers toward reversible polymerization, direct post-functionalization and chirality modulation. The interplay between the rotary molecular motion and the supramolecular systems assembly process, taking advantage of different external stimuli to govern the assembly state, provides a basis for multi-responsive supramolecular materials.</p
Environmental assessment in Estonia:A quest for an effective EA system
No full textThe effectiveness of Environmental Assessment (EA) has been intensively discussed in academia and practice. However, few studies provided a longitudinal analysis of a country or examined in-depth the interactions with the institutional context. This article aims to contribute to the understanding of EA-effectiveness by examining the interaction of EA with planning and decision-making institutions. Therefore, we present an in-depth historical analysis of how EA together with the planning and decision-making system evolved over time, using Estonia as a case. We developed an analytical framework to analyse the various effectiveness dimensions of EA (procedural, substantive, transactive, legitimacy, and knowledge& learning) and their interactions with the broader institutional setting of planning and decision-making, and conducted document analysis (of regulations, policies and evaluations), interviews and a focus group, reviewing the period between 1988 and 2024. Important findings include that the dominance of the effectiveness dimensions is dynamic characterized by the interaction between the EA-system and the broader institutional setting of the planning system. Furthermore, there is interaction between the different dimensions of effectiveness over time. This means that EA effectiveness cannot be fully understood by examining one single effectiveness dimension nor by considering EA in isolation; the broader institutional context must be considered. To improve EA effectiveness, it is crucial to acknowledge this, and to address multiple effectiveness dimensions as well as the broader institutional setting. Perhaps the key to enhancing EA effectiveness lies beyond EA itself, which aligns with its original role as an instrument to aid decision-making and planning
Economische geografie
No full textIn het vak Economische Geografie leren studenten hoe en waarom economischeactiviteiten zich op specifieke plaatsen ontwikkelen, en welke ruimtelijke enmaatschappelijke gevolgen dit heeft. Studenten leren over wereldwijde productie- en handelsnetwerken, zoals die van de iPhone, maar ook over lokale vraagstukkenzoals regionale ongelijkheid, segregatie en de rol van natuur in economische ontwikkeling
Magnetic noise in macroscopic quantum spatial superposition induced by an inverted harmonic oscillator potential
No full textWe investigate a Stern-Gerlach type matter-wave interferometer where an inhomogeneous magnetic field couples to an embedded spin in a nanoparticle to create spatial superpositions. Employing a sequence of harmonic and inverted harmonic-oscillator potentials created by external magnetic fields, we aim to enhance the one-dimensional superposition of a nanodiamond with mass ≈10−15 kg to ≈1 µm. However, random fluctuations of the magnetic field stochastically perturbs the interferometer paths and induce dephasing. We quantitatively estimate the susceptibility of the interferometer to white noise arising from magnetic-field fluctuations. Constraining the dephasing rate Γ to be low enough that the final coherence e−Γτ > 0.1 (where τ is the experimental time duration), we obtain the following bounds on the noise to signal ratios: δηIHP/ηIHP ≾ 10−13, where ηIHP is the magnetic-field curvature that gives rise to the inverted harmonic potential, and δηHP/ηHP ≾ 10−6, where ηHP is the linear magnetic-field gradient that gives rise to the harmonic potential. For such tiny fluctuations, we demonstrate that the Humpty-Dumpty problem arising from a mismatch in position and momentum does not cause a loss in contrast of the interferometer. Furthermore, we show that constraining the dephasing rate leads to stricter bounds on the noise parameters than enforcing a contrast threshold, indicating that good dephasing control ensures high interferometric contrast.</p
Pick a color to control TRP channels
No full textIdeal efficacy photoswitching is introduced as a concept in controlling protein activity with light. Largely independent of the concentration of a light-responsive compound, it enables TRPC4 and TRPC5 channels to be precisely agonized or antagonized depending on the color of light used.</p
ALMAGAL:V. Relations between the core populations and the parent clump physical properties
No full textContext. The fragmentation of massive molecular clumps into smaller, potentially star-forming cores plays a key role in the processes of high-mass star formation. The ALMAGAL project, using the Atacama Large Millimeter/submillimeter Array (ALMA), offers highr-esolution data to investigate these processes across various evolutionary stages in the Galactic plane. Aims. This study aims at correlating the fragmentation properties of massive clumps, obtained from ALMA observations, with their global physical parameters (e.g., mass, surface density, and temperature) and evolutionary indicators (e.g., luminosity-to-mass ratio and bolometric temperature) obtained from Herschel observations. It seeks to assess whether the cores evolve in number and mass in tandem with their host clumps and to determine the possible factors influencing the formation of massive cores (M > 24 M·). Methods. We analyzed the masses of 6348 fragments, estimated from 1.4 mm continuum data for 1007 ALMAGAL clumps. Leveraging this unprecedentedly large dataset, we evaluated statistical relationships between clump parameters, estimated over ∼0.1 pc scales, and fragment properties, corresponding to scales of a few thousand astronomical units, while accounting for potential biases related to distance and observational resolution. Our results were further compared with predictions from numerical simulations. Results. The fragmentation level correlates preferentially with clump surface density, supporting a scenario of density-driven fragmentation; however, it does not show any clear dependence on total clump mass. Both the mass of the most massive core and the core formation efficiency exhibit a broad range and increase, on average, by an order of magnitude across intervals defined by evolutionary indicators such as clump-dust temperature and the luminosity-to-mass ratio. This suggests that core growth continues throughout clump evolution, favoring clump-fed over core-fed theoretical scenarios. However, significant scatter in these relationships indicates that multiple factors, including magnetic fields, turbulence, and stellar feedback, not quantifiable with continuum data, influence fragmentation, as also suggested by comparison with numerical simulations.</p
Using Smartphone-Tracked Behavioral Markers to Recognize Depression and Anxiety Symptoms:Cross-Sectional Digital Phenotyping Study
No full textBackground: Depression and anxiety are prevalent but commonly missed and misdiagnosed, an important concern because many patients do not experience spontaneous recovery, and the duration of untreated illness is associated with worse outcomes. Objective: This study aims to explore the potential of using smartphone-tracked behavioral markers to support diagnostics and improve recognition of these disorders. Methods: We used the dedicated Behapp digital phenotyping platform to passively track location and app usage in 217 individuals, comprising symptomatic (n=109; depression/anxiety diagnosis or symptoms) and asymptomatic individuals (n=108; no diagnosis/symptoms). After quantifying 46 behavioral markers (eg, % time at home), we applied a machine learning approach to (1) determine which markers are relevant for depression/anxiety recognition and (2) develop and evaluate diagnostic prediction models for doing so. Results: Our analysis identifies the total number of GPS-based trajectories as a potential marker of depression/anxiety, where individuals with fewer trajectories are more likely to be symptomatic. Models using this feature in combination with demographics or in isolation outperformed demographics-only models (area under the receiver operating characteristic curveMdn=0.60 vs 0.60 vs 0.51). Conclusions: Collectively, these findings indicate that smartphone-tracked behavioral markers have limited discriminant ability in our study but potential to support future depression/anxiety diagnostics.</p
Influence of follow-up, screening age, interval, and compliance on overdiagnosis of ductal carcinoma in situ (DCIS):A modelling study
No full textOverdiagnosis estimates of ductal carcinoma in situ (DCIS) vary from 20-91%, which complicates screening communication and optimization. The aim was to quantify the influence of follow-up time and screening setting on overdiagnosis of DCIS. The fully validated micro-simulation Markov model for DCIS (SimDCIS) was used to estimate DCIS overdiagnosis in different screening settings with varying follow-up. DCIS overdiagnosis was defined as the number of diagnosed DCIS (screen-, clinically detected, or progressed to invasive breast cancer) in screening that would not have been diagnosed without screening. Outcomes were presented as overdiagnosed proportion and rate. The base cohort was screened biennially from age 50-74 with 76% compliance and 25 years (y) follow-up and compared to the non-screened cohort. Follow-up was varied from 2-25y, screening start 40-74y, screening interval 1-5y and compliance 50-100%. DCIS overdiagnosis was estimated at 20% of all diagnosed DCIS and 38.1 overdiagnosed DCIS per 100,000 women screened biennially from age 50-74 at 76% compliance and 25y follow-up. The proportion of overdiagnosed DCIS increased with shorter follow-up (27% at 2y to 20% at 25y), older screening start age (1% at 40y to 15% at 74y), decreased screening interval (23% at 1y to 12% at 5y), and increased compliance (16% at half to 20% at full participation). In conclusion, reliable DCIS overdiagnosis estimates require attention to screening setting and ≥20 years follow-up. Older women (74y) showed up to seven times more overdiagnosis at initial screening than younger women (50y). Improved estimates can provide guidance in screening communication and optimization.</p