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Placenta accreta spectrum disorders using standardised magnetic resonance imaging (MRI) descriptors; interobserver agreement and diagnostic accuracy
No full textAIM: Accurate antenatal diagnosis of placenta accreta spectrum (PAS) disorders is essential for improving maternal outcomes. To address variability in magnetic resonance imaging (MRI) interpretation for suspected PAS, the International Society for Placenta Accreta Spectrum (IS-PAS) proposed nine standardised PAS-MRI descriptors. This study evaluates their interobserver agreement and diagnostic value. MATERIALS AND METHODS: A retrospective study was conducted using MRI scans of pregnancies suspected of PAS at Maastricht University Medical Center (2010-2024). Two radiologists independently assessed the MRI scans for IS-PAS descriptors, and interobserver agreement and diagnostic performance of each descriptor were evaluated. Ultrasound (US) reports leading to MRI referral were analysed for US PAS descriptors. Histopathological or intraoperative findings served as the reference standard. RESULTS: Among 32 cases, 53% had no PAS, 37% had placenta accreta/increta, and 10% had placenta percreta. Interobserver agreement was highest for MRI descriptors 'bladder wall interruption' (kappa = 0.52) and 'focal exophytic mass' (kappa = 0.46), while 'heterogeneous placenta' (kappa = 0.12) and 'dark intraplacental bands' (kappa =-0.09) showed the lowest agreement. Sensitivity was highest for MRI descriptors 'loss of retroplacental dark zone' (100%) and 'myometrial thinning' (93%), while specificity was highest for 'bladder wall interruption' (94%) and 'focal exophytic mass' (10 0%). There were no significant differences in sensitivity and specificity between US and MRI for diagnosing PAS. CONCLUSION: IS-PAS MRI descriptors show suboptimal interobserver agreement and limited diagnostic value. Prenatal diagnosis of placenta accreta/increta remains especially challenging. Future studies should focus on validating current MRI descriptors and investigate the use of newer imaging modalities. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY license (http://creativecommons.org/licenses/ by/4.0/)
Trp1250, Lys1252 and Arg1367 of ADAMTS13 comprise a hot-spot for anti-CUB domain antibodies in patients with iTTP
No full textImmune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare life-threatening thrombotic disorder, which results from the development of autoantibodies targeting ADAMTS13. Most patients (>90%) with iTTP display antibodies against a shared epitope in the spacer domain of ADAMTS13. Nevertheless, a smaller population of patients (20%-40%) also has antibodies directed toward the CUB (complement C1r/C1s, Uegf, Bmp1) domains of ADAMTS13. Here, we explored whether anti-CUB antibodies have a shared epitope located on CUB domains of ADAMTS13 that overlaps with the spacer-CUB domain interface. Hydrogen-deuterium exchange mass spectrometry revealed that a panel of patient-derived human monoclonal anti–CUB domain antibodies specifically targeted peptides 1248-1253 and 1359-1377 in the CUB1 and CUB2 domains, respectively. A parallel alanine screen showed that residues W1250, K1252, and R1367 are crucially involved in binding of anti–CUB domain antibodies. A triple alanine variant containing W1250A/K1252A/R1367A ameliorated the binding of all patient-derived monoclonal antibodies. This triple-alanine variant also showed greatly reduced binding of anti-CUB antibodies upon analysis of plasma samples of a panel of 27 patients with iTTP. Functional analysis of the anti-CUB antibodies showed that all antibodies were able to induce an open conformation but did not inhibit activity toward either peptide substrates or von Willebrand factor multimers under flow conditions. Collectively, our findings show that anti-CUB antibodies target residues W1250/K1252 and R1367. Binding of pathogenic antibodies disrupt the spacer-CUB domain interface, thereby inducing an open conformation in ADAMTS13.</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
A scoping review of transformational leadership development in health-related PhD programs
No full textBackground: A competent public health workforce is essential for resilient health systems, where transformational leadership helps navigate complexity, drive innovation, and foster collective action. However, leadership development remains underrepresented in health-related PhD curricula, limiting their capacity to prepare future leaders. Existing evidence is sparse and often limited to clinical contexts in high-income countries, offering little guidance for broader public health needs. Objective: To explore how transformational leadership can be developed in health-related PhD programs and assess the effects of curricular elements, including content and teaching techniques. Methods: A scoping review was conducted following PRISMA-ScR and Joanna Briggs Institute guidelines, with a registered protocol on the Open Science Framework. We systematically searched Medline, PsycInfo, and ERIC (2000–2024), including peer-reviewed studies assessing how mentorship, experiential learning, and collaboration contribute to transformational leadership development. Multiple reviewers independently screened and extracted data. A narrative synthesis was conducted, and methodological quality was appraised using the Mixed Methods Appraisal Tool. Results: Of 394 records screened, seven studies met inclusion criteria. Four focused on transformational leadership; three used alternative models. All used experiential learning and collaborative feedback. Common themes included leadership, teamwork, and personal growth. Only one study used a validated tool (MLQ); others used reflective or descriptive evaluations. Most reported positive impacts, with mentoring, group learning, and reflection identified as key drivers. Conclusions: Strengthening transformational leadership in PhD education is key to preparing a future-ready public health workforce. While promising practices exist, clearer frameworks, stronger evaluation tools, and research on context-specific approaches are needed
The role of co-benefits in motivating climate change mitigation - Experimental evidence
No full textWe study the role of co-benefits - positive effects of climate change mitigation projects in addition to CO2 reduction - in motivating individuals to donate to such projects. In two artefactual field experiments conducted with large population samples (n = 2400 in total), we test how the existence and specific nature of co-benefits affect donations. In both experiments, we find that co-benefits have a positive impact on participants' willingness to donate. Moreover, our second experiment shows that contributions respond to the nature of co-benefits, and these responses seem to be driven by individuals' preferences for specific types of co-benefits. We further observe that co-benefits also increase donations when making carbon footprints and thus individual responsibility for environmental externalities more salient. In sum, our study provides a comprehensive picture of the potential of co-benefits for increasing donations to climate change mitigation projects and has several implications for the provision of co-benefits information in practice
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
Un système de sécurité sociale (trop) complexe aux Pays-Bas et ses perspectives de réforme:Pays-B as
No full textSchool 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
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