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If things were simple, word would have gotten around. Can complexity science help us improve pediatric research?
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324106.pdf (Publisher’s version ) (Open Access)Complexity science is a discipline which explores how complex systems behave and how we interact with them. Though it is widely implemented outside medicine, particularly in the sciences involving human behavior, but also in the natural sciences such as physics and biology, there are only a few applications within medical research. We propose that complexity science can provide new and helpful perspectives on complex pediatric medical problems. It can help us better understand complex systems and develop ways to cope with their inherent unpredictabilities. In this article, we provide a brief introduction of complexity science, explore why many medical problems can be considered 'complex', and discuss how we can apply this perspective to pediatric research. IMPACT: Current methods in pediatric research often focus on single mechanisms or interventions instead of systems, and tend to simplify complexity. This may not be appropriate. Complexity science provides a framework and a toolbox to better address complex problems. This review provides a starting point for the application of complexity science in pediatric research.01 augustus 202
Time-resolved single-shot imaging of ultrafast polarization dynamics in barium titanate using pump-probe second-harmonic generation microscopy
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324146.pdf (Publisher’s version ) (Open Access)9 p
Comedic entrepreneurship in the Dutch Republic: Hieronymus Sweerts and his 'Koddige en ernstige opschriften'
No full textItem does not contain fulltext24 oktober 202520 p
Molecular imaging techniques in patients with persistent spinal pain syndrome type 2 - a systematic review and meta-analysis.
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322464.pdf (Publisher’s version ) (Open Access)BACKGROUND: Persistent postoperative low back pain, including persistent spinal pain syndrome type 2 (PSPS-T2), is a global healthcare challenge that lacks objective phenotypic diagnostic criteria or validated biomarkers. Molecular imaging techniques (nuclear medicine) could aid in establishing more objective phenotypical parameters as they are able to visualize biological processes underlying several diseases even before anatomical changes are present. This review aims to provide an overview of the status quo of molecular imaging for the diagnosis of PSPS-T2. METHOD AND RESULTS: An extensive search of PubMed and Embase was conducted to identify relevant studies that comprise imaging techniques using a radiopharmaceutical substance. Evidence reveals that these techniques can provide valuable insights into the underlying pathologies and mechanisms of PSPS-T2 by detecting pain generators that would have otherwise gone unnoticed. Moreover, the meta-analysis showed a pooled sensitivity of 90.3% (95% CI: 53–100%) and a specificity of 89.1% (95% CI: 31–100%) for [(18)F]NaF PET-CT, and a pooled sensitivity of 61.5% (95% CI: 7–93%) and specificity of 96% (95% CI: 21–100%) for diphosphonates SPECT-CT. CONCLUSION: These findings suggest a potential utility in identifying those who are likely to benefit from surgical re-intervention. This illustrates the potential of molecular imaging in establishing a personalized-medicine approach. However, the retrospective design and the limited sample sizes are among the limitations of the included studies and further research is needed to unravel the potential of molecular imaging techniques as a tool to detect phenotypical biomarkers and to optimize patient care in patients with persistent postoperative low back pain, including PSPS-T2
From Planning to Presence: The Power of a ‘5-to-12 Death’ and the Emergence of Meaningful Rituals around the Euthanasia Day
No full textItem does not contain fulltextVisitation American Right to Die Organization, 10 oktober 2025NVV
Patient reported medication-related problems, adherence and waste of oral anticancer medication over time.
No full textItem does not contain fulltextOBJECTIVES: Patients on oral anticancer therapy regularly experience medication-related problems (MRPs), potentially leading to non-adherence and medication waste. Most studies reporting these experiences have cross-sectional designs. The aim of our study was to explore patient reported MRPs, adherence and waste of oral anticancer medication over time. METHODS: A prospective longitudinal quantitative interview study with 4 months follow-up was performed among patients on oral anticancer medication (mainly tyrosine kinase inhibitors, (anti)hormonal therapy, pyrimidine antagonists) using a semi-structured questionnaire. Patients from two Dutch university medical centres were included from March to December 2022 after informed consent was given. Four interviews were performed with 1 month in between. All interviews were audiotaped, after which the data were entered into an electronic case report form. The primary outcome was the mean number of MRPs per patient per interview round. Secondary outcomes were the proportion of patients with at least one MRP, types of MRPs, perceived non-adherence, medication waste (both in general and specifically for anticancer medication), costs of anticancer medication waste, and factors associated with medication waste as mentioned by the patient. Descriptive statistics were used to analyse the data. RESULTS: Forty patients were included with a mean (SD) age of 64 (9) years; 43% were male. The mean number of MRPs per patient was 2.1 in the first interview and 1.2, 1.0 and 0.9 in the second, third and fourth interviews, respectively. Adverse drug reactions were the most frequently reported type of MRPs (30 (75%) patients in the first interview and 19 (65%) in the last interview). Unintentional non-adherence was regularly reported, especially in the first interview. Medication changes were frequent and associated medication waste was mentioned in all interviews. CONCLUSIONS: Many patients using oral anticancer treatment report MRPs and this number remains substantial over time
Prudentieel toezicht op beleggingsondernemingen
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324628.pdf (Publisher’s version ) (Closed access)7 p
De vergeten kloof: Waarom bestaanszekerheid ook over waardigheid moet gaan
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324176.pdf (Publisher’s version ) (Closed access)Sinds de laatste Kamerverkiezingen is bestaanszekerheid hét politieke toverwoord. Politieke partijen proberen elkaar te overtreffen met koopkrachtmaatregelen, loonplannen en andere voorstellen om de onzekere werkenden meer zekerheid te verschaffen. Deze hernieuwde aandacht voor materiële zekerheid is winst, maar schiet ook tekort. Bestaanszekerheid is namelijk niet alleen een economische kwestie - het is ook sociaal en cultureel. Wie financieel rondkomt, kan zich alsnog onzichtbaar voelen. Wie werkt, maar geen erkenning ervaart, raakt vervreemd. De onzekere werkenden hebben niet alleen last van een inkomenskloof, maar ook een waardigheidskloof.4 p
Functional Innovation in Bookcraft in Roman Egypt
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326583.pdf (Publisher’s version ) (Open Access
Navigating complexity: The challenge of reaching consensus on the diagnosis of malnutrition in patients with obesity via a modified delphi study
No full textItem does not contain fulltextBACKGROUND & AIM: Diagnosing (disease-related) malnutrition in patients with obesity is challenging due to the complex interplay between excess body weight and physiological changes associated with illness and inadequate dietary intake, factors often overlooked in clinical assessments. Current global definitions of malnutrition do not adequately account for the distinctive characteristics of patients with obesity. This study aimed to develop a working definition of malnutrition in this population. METHODS: A modified three-round Delphi method was conducted between March and July 2024, involving 25 experts to achieve consensus on diagnosing malnutrition in obesity. In Round 1, participants evaluated 45 statements using a 5-point Likert scale. Feedback from this round guided revisions for Round 2, which focused on the Global Leadership Initiative on Malnutrition (GLIM) criteria and introduced nine revised statements. Round 3 further refined these statements, with the final consensus assessed using a binary agree/disagree scale. A threshold of ≥70 % agreement was set to define consensus in all rounds, with statements not meeting this threshold left undecided. RESULTS: Participation rates were 88 % (n = 22) in Round 1, 77 % (n = 17) in Round 2, and 50 % (n = 11) in Round 3. Of the 45 statements assessed in Round 1, 11 were accepted, 32 were undecided, and two were rejected. Round 2 introduced nine revised statements, of which seven were accepted and two remained undecided. In Round 3, nine statements were assessed, of which six were accepted, and three remained undecided. Consensus supported adopting the GLIM criteria as the foundation for the working definition. However, thresholds for weight loss and muscle mass and the relevance of functional parameters remained unresolved. C-reactive protein thresholds were agreed upon, but their relevance was debated due to the challenges in interpreting chronic low-grade inflammation in obesity. Participants emphasised the importance of assessing dietary quality and quantity, recommending dietitian involvement for improved accuracy. CONCLUSION: Although a working definition for diagnosing malnutrition in patients with obesity was not achieved, this study lays a crucial foundation for further research. Key areas for future investigation include refining and validating parameters related to involuntary weight loss, muscle mass, inflammatory markers and dietary intake