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Network dynamics of self-compassion, anxiety, and depression during eating disorder therapy
Get PDFBackgroundRecovery processes during residential treatment for eating disorders, especially in patients with a history of maltreatment, are insufficiently understood. This study aimed to explore the temporal relationships among comorbid factors, including depression, anxiety, and self-compassion, with the influence of childhood maltreatment.MethodUsing Dynamic Time Warp (DTW), weekly scores from the Symptom Checklist-5, Eating Disorder Examination, and Self-Compassion Scale were analysed over 12 weeks. The study generated undirected and directed networks to identify influential symptoms in a transdiagnostic sample, comparing patients with and without childhood maltreatment.ResultsThe study included 124 patients with eating disorders (ED) (97% women), mean age of 30.9 years (SD = 9.7, range 18–61 years). Diagnoses included anorexia nervosa (26%), bulimia nervosa (38%), and other specified feeding and eating disorders (36%). The directed DTW network showed that hopelessness, worrying, and restlessness had the highest out-strength, predicting changes in self-compassion and ED behaviour. In maltreatment cases, hopelessness and low acceptance predicted changes, while worry, restlessness, and nervousness were predictive in non-maltreatment cases.ConclusionTemporal network analyses suggest that a change in hopelessness, worrying, and restlessness drives symptom improvement in ED behaviour and the development of self-compassion during residential treatment. These processes vary between patients with and without a history of childhood maltreatment separately, indicating the need for further analyses.Public Health and primary carePrevention, Population and Disease management (PrePoD
Distinct clinical outcomes based on multiple serum cytokine and chemokine profiles rather than autoantibody profiles and ultrasound findings in rheumatoid arthritis: a prospective ultrasound cohort study
Get PDFObjectives To evaluate the potential of clinical factors, ultrasound findings, serum autoantibodies, and serum cytokine and chemokine profiles as predictors of clinical outcomes in rheumatoid arthritis (RA).Patients and methods We included 200 patients with RA treated with biological and targeted synthetic disease-modifying antirheumatic drugs in a prospective multicentre ultrasound cohort study. Their serum levels of multiple cytokines and chemokines, rheumatoid factors, and serum autoantibodies (anti-cyclic citrullinated peptide-2 (anti-CCP2) and anti-carbamylated protein antibodies) were measured at baseline, 3 months and 12 months.Results Dimensionality reduction using 38 cytokines and chemokines demonstrated four distinct clusters that differed significantly regarding the frequencies of remission defined by clinical composite measures and ultrasound evaluations. Prominent differences in IL-1β, IL-5, IL-7, IL-10, IFNγ, GRO, IP-10, MCP-1 and MIP-1β characterised the between-cluster differences. Two distinct groups made of four clusters showed a significant difference in IgM-anti-CCP2 positivity. The least absolute shrinkage and selection operator regression of 38 cytokines and chemokines for Clinical Disease Activity Index (CDAI) remission at 12 months resulted in the selection of MIP-1β. Logistic regression using baseline levels of anti-citrullinated protein antibody, IgM-anti-CCP2 positivity, the CDAI, the total power Doppler score, the cluster by cytokines and chemokines, MIP-1β, methotrexate dose and mechanisms of action revealed that cluster by cytokines and chemokines was the sole significant factor for CDAI remission at 12 months.Conclusions Specific patterns of cytokines and chemokines—no other clinical factors and autoantibody profiles—were important to distinguish patients with RA achieving remission at 12 months.Trial registration number UMIN000012524.</p
Which topics are best represented by science maps?: An analysis of clustering effectiveness for citation and text similarity networks
Get PDFA science map of topics is a visualization that shows topics identified algorithmically based on the bibliographic metadata of scientific publications. In practice not all topics are well represented in a science map. We analyzed how effectively different topics are represented in science maps created by clustering biomedical publications. To achieve this, we investigated which topic categories, obtained from MeSH terms, are better represented in science maps based on citation or text similarity networks. To evaluate the clustering effectiveness of topics, we determined the extent to which documents belonging to the same topic are grouped together in the same cluster. We found that the best and worst represented topic categories are the same for citation and text similarity networks. The best represented topic categories are diseases, psychology, anatomy, organisms and the techniques and equipment used for diagnostics and therapy, while the worst represented topic categories are natural science fields, geographical entities, information sciences and health care and occupations. Furthermore, for the diseases and organisms topic categories and for science maps with smaller clusters, we found that topics tend to be better represented in citation similarity networks than in text similarity networks.Algorithms and the Foundations of Software technolog
Surveillance in inflammatory bowel disease: white light endoscopy with segmental re-inspection versus dye-based chromoendoscopy - a multi-arm randomised controlled trial (HELIOS)
Get PDFBackground It remains unclear if the increased colorectal neoplasia detection rate in inflammatory bowel disease (IBD) by high-definition (HD) dye-based chromoendoscopy compared with HD white-light endoscopy is due to enhanced contrast or increased inspection times. Longer withdrawal times may yield similar neoplasia detection rates as found by HD chromoendoscopy.Objective To compare colorectal neoplasia detection rates for HD white-light endoscopy with segmental re-inspection and HD chromoendoscopy, using single-pass HD white-light endoscopy as an additional control group.Design In a multicentre, randomised controlled trial, IBD patients aged ≥18 years without active disease and scheduled for endoscopic surveillance were included. Patients were 2:2:1 randomised to HD white-light endoscopy with segmental re-inspection of each colonic segment (double pass), HD chromoendoscopy or single-pass HD white-light endoscopy. The primary outcome was colorectal neoplasia detection rate. Assuming equal colorectal neoplasia rates (non-inferiority margin of 10%) between segmental re-inspection and chromoendoscopy and superiority of segmental re-inspection vs single-pass HD white-light endoscopy, a sample size of 566 patients was required.Results In total, 563 patients were analysed per-protocol. Colorectal neoplasia detection rates were 10.3% (n=24/234) for HD white-light endoscopy with segmental re-inspection and 13.1% (n=28/214) for HD chromoendoscopy. This confirmed non-inferiority to HD chromoendoscopy (Δ−2.8%, lower limit 95% CI −7.8, pConclusions HD white-light endoscopy with segmental re-inspection was non-inferior to HD chromoendoscopy for colorectal neoplasia detection in IBD patients. It can therefore be assumed that the benefit of HD chromoendoscopy may be explained by the longer withdrawal time and not necessarily the enhanced contrast. However, re-inspection per se did not lead to a significantly higher colorectal neoplasia rate than single-pass HD white-light endoscopy alone.Cellular mechanisms in basic and clinical gastroenterology and hepatolog
De meerwaarde van methodologie: op weg naar het verantwoord verantwoorden van onderzoek
Get PDFVier promovendi roepen op tot meer expliciete methodologie. In veel fiscale tijdschriftartikelen ontbreekt op dit moment een duidelijke aanpak, terwijl dat de argumenten robuuster zou maken. Expliciete methodologie is daarmee waardevol voor zowel auteurs als lezers. Specifiek voor de laatstgenoemden kan frustratie vanwege onduidelijke afslagen worden weggenomen tijdens het lezen en wordt het gebruik van vakliteratuur in de dagelijkse praktijk toegankelijker. De bij dra ge biedt ten slotte handvatten voor auteurs voor expliciete methodologie, met de hoop dat dit in de toekomst de norm wordt.Grenzen van fiscale soevereinitei
De toepassing van toewijzingsbepalingen in belastingverdragen
Get PDFIn dit artikel gaan de auteurs in op de toepassing van toewijzingsbepalingen in belastingverdragen. Zij gaan op hoofdlijnen in op de vraag welke overeenkomsten en verschillen er tussen deze bepalingen zijn. Verder bespreken de auteurs de verhouding tussen de verschillende toewijzingsbepalingen. Aan de orde komen verder de beperkende werking van belastingverdragen, een aantal toepassingsvoorwaarden van toewijzingsbepalingen, de paraplubepalingen, de rol van het restartikel en de overlap van toewijzingsbepalingenGrenzen van fiscale soevereinitei
Care and decision-making at the end of life for migrants living in the Netherlands: an intersectional analysis
Get PDFAs migrant populations age, the care system is confronted with the question how to respond to care needs of an increasingly diverse population of older adults. We used qualitative intersectional analysis to examine differential preferences and experiences with care at the end of life of twenty-five patients and their relatives from Suriname, Morocco and Turkey living in The Netherlands. Our analysis focused on the question how - in light of impairment - ethnicity, religion and gender intersect to create differences in social position that shape preferences and experiences related to three main themes: place of care at the end of life; discussing prognosis, advance care, and end-of-life care; and, end-of-life decision-making. Our findings show that belonging to an ethnic or religious minority brings forth concerns about responsive care. In the nursing home, patients' minority position and the interplay thereof with gender make it difficult for female patients to request and receive responsive care. Patients with a strong religious affiliation prefer to discuss diagnosis but not prognosis. These preferences are at interplay with factors related to socioeconomic status. The oversight of this variance hampers responsive care for patients and relatives. Preferences for discussion of medical aspects of care are subject to functional impairment and faith. Personal values and goals often remain unexpressed. Lastly, preferences regarding medical end-of-life decisions are foremost subject to religious affiliation and associated moral values. Respondents' impairment and limited Dutch language proficiency requires their children to be involved in decision-making. Intersecting gendered care roles determine that mostly daughters are involved. Considering the interplay of aspects of social identity and their effect on social positioning, and pro-active enquiry into values, goals and preferences for end-of-life care of patients and their relatives are paramount to achieve person centred and family-oriented care responsive to the needs of diverse communities.Analysis and support of clinical decision makin
Multiple perspectives on the need for real-world evidence to inform regulatory and health technology assessment decision-making: scoping review and stakeholder interviews
Get PDFPurposeReal-world evidence (RWE) is increasingly considered in regulatory and health technology assessment (HTA) decision-making, though perspectives on its relevance may vary. Expanding on a recent review regarding regulatory decisions, this study aimed to identify factors influencing the need for RWE in HTA decision-making, confirm and enrich factors with stakeholder views, and evaluate similarities and differences between regulatory and HTA needs.MethodsPrevious scoping review methodology was used to identify factors influencing the need for RWE in HTA decision-making. Semi-structured interviews with stakeholders were conducted to confirm and enrich literature-derived factors for both regulatory and HTA contexts. Insights from the reviews and interviews were combined to explore similarities and differences in RWE needs across these domains.ResultsThe HTA review, featuring 118 articles, revealed two major themes and six subthemes, encompassing 45 factors. The need for RWE depended on (1) questions addressable with RWE, and (2) contextual factors. Stakeholder interviews confirmed literature-derived factors. While contextual factors aligned between regulatory and HTA decision-making, question-related factors partly differed. Unlike the benefit–risk assessment in regulatory decision-making, RWE serves as direct input for the HTA, and involves specific details and a broader scope. Regulators require RWE for orphan status submissions, alternative approval pathways and to evaluate the impact of risk minimization measures, whereas HTA uses RWE to guide comparator selection, evaluate treatment implementation, quality of care and general healthcare impacts.ConclusionContextual factors that influence the need for RWE are similar between regulatory and HTA decision-making, with variations seen in questions addressable with RWE.Metabolic health: pathophysiological trajectories and therap
Opening up creative resources: towards age-friendly communities through rhizomatic thinking and doing
Get PDFGlobally, many complex issues, like the ageing population and health inequalities, require attention. People are experimenting to combat these issues in their local contexts through bigger or smaller networks; however, much of the knowledge about these initiatives remains localised and elitist and omits the voices and perspectives of citizens. This article identifies the characteristics of a more horizontal, emergent and plural epistemology to mobilize knowledge. We used local networks building age-friendly communities in the Netherlands as a case study. With members of 110 local networks, we worked with a new methodology called dynamic knowledge synthesis to create fruitful interactions and learn with stakeholders, including older citizens, in a learning community. Four working principles helped us, namely (1) a rhizomatic design based on multiplicity, heterogeneity and non-linearity of knowledge; (2) fertile soil nurtured by the talents and wisdom of participants through participatory arts-based methods; (3) so-called ‘wicked skills’ of a forester 2.0 to facilitate learning; and (4) an ecosystem metaphor as a boundary object to understand local networks. We invite colleagues to experiment with dynamic knowledge synthesis to connect on different levels, with particular attention to the inclusion of citizens in creating sustainable local communities.Public Health and primary carePrevention, Population and Disease management (PrePoD