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School Performance After Maintenance Tocolysis With Nifedipine for Threatened Preterm Birth:12-Year Follow-Up of the APOSTEL 2 Trial
No full textObjective To evaluate school performance at 12 years of age in children prenatally exposed to maintenance tocolysis with nifedipine versus placebo.Design 12-year follow-up of the multicentre APOSTEL 2 trial, in which participants with threatened preterm birth between 26+0 and 32+2 weeks of gestation, who remained pregnant after initial 48-h tocolysis, were randomised to nifedipine maintenance tocolysis or placebo for up to 12 days.Setting The APOSTEL 2 trial was conducted in 11 Dutch hospitals from 2008 to 2010. School outcomes were assessed at age 12.Participants Children from singleton and multiple pregnancies born to APOSTEL 2 participants.Methods School performance data were received through linkage with a national registry (Statistics Netherlands).Main Outcome Measures A high track recommendation for secondary school, adjusted for maternal education level, socioeconomic status, and child's biological sex.Results Of 492 eligible children, 357 were included (follow-up rate 73%). In the nifedipine group, significantly fewer children received a high track recommendation for secondary school, 67/189 (35.4%), compared to 74/168 (44.0%) in the placebo group (adjusted risk ratio (aRR) 0.76; 95% confidence interval (CI) 0.61-0.95). Outcomes were significantly poorer in children with the longest nifedipine exposure (9-14 days) compared to those not exposed (aRR 0.58; 95% CI 0.41-0.83).Conclusions Children prenatally exposed to maintenance tocolysis with nifedipine had significantly poorer school performance at 12 years of age compared to those exposed to placebo. These findings further discourage nifedipine's use for maintenance tocolysis, and more research is warranted regarding its long-term effects on child development
Extension of Industrial and Collaborative Robots for Increased Work Space and Operation in Confined Spaces
No full textCollaborative robots, such as the KUKA LBR iiwa, UR series from Universal Robotics, and many more, have opened new fields of applications in industries through human-robot collaboration. However, despite up to seven rotational degrees of freedom typically offered by commercial collaborative (and industrial) robots, the operational reach is often not sufficient. This prevents these robots from reaching into and operating within confined spaces autonomously or in collaboration with human co-workers. To overcome these limitations, this paper presents a custom-made, open-source, affordable robot arm extension to be mounted on commercial or custom-made robots. The developed solution adds three additional degrees of freedom, including a 0.5 m linear rail. These additional degrees of freedom of the robot extension significantly increase the reach and ability of industrial and collaborative robots to operate in narrow environments. The developed extension is demonstrated by extending a KUKA LBR iiwa 14 collaborative robot operating various insect farming use cases, including tasks such as reaching into crates for insect rearing, operating within caged enclosures, and material handling over a wider workspace. Furthermore, simulations are used to provide insights into the extended reach of the robot. Simulation results show an increase in total operational space by up to 110%, and a 200% increase in positions reachable from =50% of tested orientations, compared to a baseline KUKA iiwa
Association of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) with survival in patients with oligometastatic non-small-cell lung cancer treated with immunotherapy:a multicentre retrospective study
No full textPurpose: Current guidelines recommend adding local radical therapy (LRT) to systemic treatment in synchronous oligometastatic non-small-cell lung cancer (sOM-NSCLC), but survival data on immunotherapy-based regimens are limited. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are prognostic in NSCLC, with higher values linked to worse outcomes. This study examines their association with survival in sOM-NSCLC patients treated with immunotherapy. Methods: We conducted a multicenter retrospective study including all consecutive patients with [ 18F]FDG-PET and brain imaging-staged sOM-NSCLC, between 2015 and 2022, who received first-line (chemo)-immunotherapy and had baseline PET-scan available for review. Subgroups were analyzed based on median MTV and TLG values (high vs. low: H-MTV vs. L-MTV, H-TLG vs. L-TLG). Study endpoints were progression-free survival (PFS) and overall survival (OS), according to MTV and TLG distribution (high vs. low), in the overall population (primary endpoint) and in relation to LRT and systemic treatment type (secondary endpoints). Results: 105 patients were included, 50% were male and 73% had non-squamous histology, median age was 64.9 years. Median PFS was significantly longer for L-MTV vs. H-MTV (14.73 months (95%CI, 7.06–22.40) vs. 7.63 months (95%CI, 5.73–9.52), p = 0.028), but also LRT was associated with PFS (19.04 months (95%CI, 8.47–29.60) versus 7.46 months (95%CI, 5.25–9.67), p = 0.045), while neither MTV nor TLG had impact on OS. In multivariate analysis, only PD-L1 < 50% and soft tissue metastases remained significantly associated with shorter PFS. Conclusions: Baseline MTV is preliminarily associated with PFS in sOM-NSCLC patients treated with immunotherapy, but results are exploratory and need prospective validation in larger cohorts.</p
Exploring the links between dissociative experiences, schemas, modes, and coping
No full textThis study explored the relationships between dissociative experiences, childhood trauma, maladaptive schemas, schema modes, and schema coping in a nonclinical sample. Three theoretical models were tested: (1) dissociative experiences resulting from schema mode activation, (2) dissociative experiences as an innate trait shaping schema coping, and (3) dissociative experiences arising from childhood trauma that influence coping strategies. Data from 401 Dutch psychology students were analyzed using path analyses to compare model fit. While all models showed good fit, Model 2 emerged as the best based on AIC and BIC values. This model linked dissociative experiences to avoidance and surrender coping styles and specific schema modes, such as the punitive parent and detached self-soother. Findings suggest dissociative experiences shape responses to schema-related stress through disengagement or immersion. Future research in clinical populations is recommended to further explore these dynamics and their therapeutic relevance
Current Controversies and Challenges in Non-Oncogene-Addicted Synchronous Oligometastatic Non-Small Cell Lung Cancer:A Review
No full textIMPORTANCE: It has been stated that especially with the advancements in imaging, systemic therapy, and local radical treatment (LRT) that patients with synchronous oligometastatic disease (sOMD) can potentially benefit from curative-intent treatment. This statement is challenged by the results of the NRG-LU002 randomized phase 2/3 trial, showing no significant progression-free survival and overall survival improvements with the addition of LRT to maintenance systemic therapy in patients with oligometastatic non-small cell lung cancer (NSCLC) who achieved at least stable disease after induction systemic therapy (approximately 90% received an immunotherapy-based regimen). This Review discusses the current challenges and controversies in the treatment of non-oncogene-addicted sOMD. OBSERVATIONS: Whether LRT indeed can improve survival in a contemporary immunotherapy-based systemic treatment regimen is discussed as well as the optimal treatment sequence. Moreover, the NRG-LU002 trial also sparks debate of whether a true sOMD state exists. Genomic alterations, the tumor microenvironment of the primary tumor and metastasis, organotropism, and tumor heterogeneity can all influence metastatic potential, giving a biological explanation that there could be existence of a true sOMD state. However, as true sOMD cannot be distinguished from early-detected widespread metastatic disease with the current imaging modalities, it becomes difficult to select patients for a radical strategy and protect patients from futile treatment. CONCLUSIONS AND RELEVANCE: It remains under debate whether synchronous oligometastatic NSCLC represents a distinct biological entity or merely a probabilistic imaging finding. Biomarkers such as circulating tumor DNA, microRNA, and radiomics may improve patient selection but require further validation. Clinical trials should prioritize translational research to address these challenges
Cultural Diversity in Academic Motivation: Universality and Model Complexity
No full textThis contribution centres on two interconnected conjectures. The first posits that motivational—and the way we model what influences motivation— can be significantly enhanced by integrating the concept of growth orientation. This integration enables to connect growth mindset frameworks and motivational theories through straightforward antecedent-consequence models. The second conjecture is that simpler models tend to vary less and are more stable across different groups compared to more complex models. An example brings these two conjectures together by analysing cultural differences in academic motivation. It compares three models using data from international students studying mathematics and statistics: (1) a comprehensive growth orientation model incorporating both global and specific factors, estimated using Bifactor Exploratory Structural Equation Modelling (B-ESEM); (2) a simplified version of this model with growth orientation as the sole antecedent factor; and (3) a Structural Equation Model (SEM) using specific factors as antecedents. In the illustrative example, the degree of cultural diversity in motivational levels is found to be relatively small, comparable in magnitude to gender differences. However, more complex antecedent-consequence models can easily lead to the conclusion that significant diversity exists between cultural groups. Our findings challenge common assumptions about the cultural specificity of academic motivation models and highlight a promising yet often overlooked factor for building robust explanations of learning motivation: students’ growth orientation
Arm-hand training strategies and therapy dose dimensions during the subacute rehabilitation of people with cervical spinal cord injury:a longitudinal observational study
No full textSTUDY DESIGN: Longitudinal observational study.OBJECTIVES: To explore motor training strategies, therapy dosage, and motivation in subacute arm-hand rehabilitation for individuals with cervical spinal cord injury and their change over a 6-month rehabilitation period.SETTING: Three rehabilitation centers in Belgium and the Netherlands.METHODS: Individuals with lesions between C1-Th1 and AIS A-D were included between 4-8 weeks post-injury and observed for three weeks with an eight-week interval. Regular arm-hand training sessions, with at least 25% arm-hand training, were analyzed. Motor training strategies, therapy dosage, and motivation were collected by two trained observers, video recordings and patient-reported outcome measures.RESULTS: 240 Sessions from thirteen participants (mean age 54.4 ± 12.9; C1-C5; AIS B-D) were included. Analytical training showed the highest active arm-hand use (30.3%), followed by skill training (26.6%). Of the 15 task-oriented components, only multiple movement planes, functional movements, and feedback were used in ≥60% of sessions. Actual session time averaged 78.3% of the planned duration. During the arm-hand session, 52.1% of the time involved active time. Skill training showed the lowest number of repetitions (MED: 66.5). Participants reported low physical fatigue (4/10) and difficulty (4/10) but high motivation (7/10). Limited changes in training variables were observed over six months.CONCLUSION: Our findings reveal a gap between clinical practice and evidence-based guidelines for arm-hand training. Despite its importance, skill training and key task-oriented components are underused. Low perceived difficulty and intensity, contrasted with high motivation, suggest the potential to increase therapy doses for better rehabilitation outcomes.</p
What do R&D spillovers from universities and firms contribute to productivity? Plant level productivity and technological and geographic proximity in Japan
No full textWe examine the simultaneous influences of spillovers due to R&D by firms and universities on total factor productivity in a panel of over 20,000 Japanese manufacturing plants in Japan. Estimating fixed effects models and taking into account the geographic distribution of the population of plants operated by firms with R&D activities as well as the population of universities in Japan, we find a positive influence of both firm and university R&D that is technologically proximate. Inter-plant R&D spillovers decay exponentially in distance and lose 80% of their strength at a distance of 200 km. University R&D spillovers occur in proximity and are only significant at the municipal level. Decomposition analysis shows that the exit of geographically proximate plants operated by R&D intensive firms, which may be associated with a relocation of manufacturing activity abroad, plays a notable role in declining R&D spillovers and is an important phenomenon in major industrial agglomerations such as Tokyo and Osaka
In vitro kinematic analysis of a new patient-matched polycarbonate urethane radiocarpal interposition arthroplasty
No full textCurrent salvage procedures for patients with post-traumatic wrist osteoarthritis include excision of bone or tissue and/or fusion of wrist bones, making all surgical salvage procedures irreversible. Some of these salvage procedures decrease wrist mobility. A novel patient-matched polyurethane carbonate (PCU) radiocarpal interposition arthroplasty has recently been proposed as a reversible, motion-preserving solution. This experimental study evaluates the effect of the PCU radiocarpal implant on wrist range of motion (ROM) and carpal kinematics. Additionally, implant displacement is assessed during functional ROM. The passive wrist ROM of three cadaveric arms was measured in a wrist motion simulator before and after implantation of the PCU radiocarpal implant by applying a 1 Nm Torque. Three-dimensional fluoroscopy scans of the wrist were acquired in 15° steps during flexion-extension (F/E = 60°/60°) to assess carpal bone and implant kinematics. The mean differences in carpal kinematics between native and implantation conditions were calculated per cadaveric wrist and averaged across all three specimens. The mean wrist ROM did not demonstrate clinically relevant differences between the native and implantation conditions, except for a reduction of 10.3° in extension. Variations in carpal rotations and translations over the F/E curve were smaller than 2.5° and 2.2 mm and were therefore considered negligible. The PCU radiocarpal implants' rotations and translations were maximally 6.3° and 1.1 mm during F/E. Given these results, the PCU radiocarpal interposition arthroplasty may be a promising option for patients with post-traumatic radiocarpal arthritis, offering a balance between maintaining mobility and providing pain relief through a minimally invasive and reversible procedure
