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The Full Burden of RSV-related Pediatric Intensive Care Unit Admissions During Infancy:A Prospective National Study (BRICK Study)
No full textBackground: Worldwide, respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections during infancy. Approximately 5% of hospitalized infants require pediatric intensive care unit (PICU) admission. Our objective was to capture a complete overview of the PICU admission, including the yet unseen burden, to understand the full clinical impact of new preventive interventions. Methods: A nationwide, prospective, observational, multicenter study was performed in the Netherlands. Patients included infants <12 months with laboratory-confirmed RSV-related PICU admission. Collected data were clinical characteristics, unwanted and detrimental events during admission and parental signs of post-traumatic stress disorder (PTSD) after admission. Results: Of 423 patients, most were term born (n=335, 79.2%) and had no comorbidities (n=292, 69.0%). Median age was 46 (interquartile range, 25.0-89.0) days. Invasive mechanical ventilation was used in 258 (61.1%) patients. In total, 51 unwanted events were observed in 48 (11.3%) patients. Events occurred more frequently in patients receiving invasive mechanical ventilation compared to patients receiving other types of respiratory support (91.9% versus 52.4%; P < 0.001). Three (0.7%) patients died, all with severe comorbidities. Follow-up showed signs of PTSD in 35/120 (29.2%) of the parents. Conclusions: The burden of severe RSV disease is broader than the PICU admission alone. During admission, 11% of infants experienced unwanted, detrimental events, and one-third of parents showed signs or symptoms of PTSD. Because 75% of infants were <3 months of age, the introduction of RSV immunization into the Dutch immunization program could have the potential to significantly decrease this yet unseen RSV burden too
How policy capacities shape the green transition:explaining the use of EU sustainable finance in the EU's Central and Eastern European member states
No full textThis article investigates how policy capacities influence governments' decisions on allocating funding for the green transition. Our theoretical framework outlines how political, analytical and operational capacities can be expected to affect green transition funding. We probe the plausibility of these linkages by examining how EU member states from Central and Eastern Europe are using the European Recovery and Resilience Facility - the EU's main 'green recovery' financial instrument, which runs parallel to regulatory attempts of aligning private financial flows with climate mitigation and adaptation. In a comparative case study of Bulgaria and Estonia, we analyse how different configurations of policy capacities have influenced the allocation of green transition funding in the countries' Resilience and Recovery Plans (RRPs). We show that the distinct configurations of policy capacities contributed to significant differences between Estonia and Bulgaria. Political capacities affected the prioritisation of the green transition agenda in the RRPs, while analytical and operational capacities shaped the private-public mix, legacy v. future-orientedness, and technological v. behavioural focus in the selected projects and investments
The Association Between Heatmap Position and the Diagnostic Accuracy of Artificial Intelligence for Colorectal Polyp Diagnosis
No full textBackground/Objectives: Artificial intelligence (AI) algorithms for diagnosing colorectal polyps are emerging but not yet widely used. Trust in AI is lacking and could be improved by visually explainable AI, such as heatmaps. This study aims to investigate the association between heatmap position and AI accuracy for the endoscopic characterization of colorectal polyps. Methods: Four AI algorithms diagnosed 2133 prospectively collected images of 376 colorectal polyps from two hospitals, using histopathology as the gold standard. Heatmap position was compared to the human-annotated polyp position. Generalized estimating equations were used to assess the association between heatmap position and a correct AI diagnosis. Results: Higher percentages of heatmap covering the colorectal polyp were associated with correct diagnoses in all four algorithms (OR 1.013 [95% CI 1.006-1.019], OR 1.025 [95% CI 1.011-1.039], OR 1.038 [95% CI 1.024-1.053], and OR 1.039 [95% CI 1.020-1.058]-all p < 0.001). A higher percentage of polyp not covered by heatmap was associated with a correct diagnosis of Algorithm 1 (OR 1.006 [95% CI 1.003-1.010], p < 0.001), while in Algorithm 2, a lower percentage was associated with a correct diagnosis (OR 0.992 [95% CI 0.985-1.000], p 0.044). Algorithms 3 and 4 showed negative, but not statistically significant, associations. Conclusions: Higher percentages of heatmap covering the polyp were associated with correct diagnoses of four AI algorithms. This indicates that it is clinically relevant to strive for AI predictions with heatmaps covering as much colorectal polyp tissue as possible. Knowing how to interpret heatmaps could increase trust in AI and, with that, benefit the implementation of AI in clinical practice
European coordinators as senior policy intermediaries in the implementation of the trans-European transport network
No full textThis article aims to explore the role of intermediaries in the process of policy coordination at the EU level. It explores the case of the European Coordinators (ECs) in the EU's Trans-European transport networks policy and its many ambitious infrastructure projects. The recently revised regulation (2024) provides a clearer political message, strengthening the role, function, and powers of ECs. This exploratory article provides a thematic analysis, problematizing their role and legitimacy in light of their ongoing institutionalization. It asks how, and to what extent, one can explain trans-European networks (TENs) policy successes and failures via the intermediation perspective. It aims to contribute to a more expansive understanding of intermediation in public policy by exploring notions of capacity, expertise, independence, and legitimacy with a focus on the informal roles of such intermediaries in transnational multistakeholder regulation and governance, and of deliberation. The article questions the role and function of former EU officials and high-level politicians as ECs, examining their mechanisms of action and interactions in stakeholder forums. It considers how we might conceive of their added value in problem solving, namely in improving policy coordination (and securing project completion), but also what the TENs case findings contribute to the theory of intermediation. The analysis finds informalism and forums, as found within experimentalist governance, to be key features of TENs policy intermediation, helping us better understand the role, capacity, and impact of ECs as negotiators and interlocutors. Incorporating these features within typologies of policy intermediation may strengthen their application and analytical power
ESR Essentials:a step-by-step guide of segmentation for radiologists-practice recommendations by the European Society of Medical Imaging Informatics
No full textAbstract: High-quality segmentation is important for AI-driven radiological research and clinical practice, with the potential to play an even more prominent role in the future. As medical imaging advances, accurately segmenting anatomical and pathological structures is increasingly used to obtain quantitative data and valuable insights. Segmentation and volumetric analysis could enable more precise diagnosis, treatment planning, and patient monitoring. These guidelines aim to improve segmentation accuracy and consistency, allowing for better decision-making in both research and clinical environments. Practical advice on planning and organization is provided, focusing on quality, precision, and communication among clinical teams. Additionally, tips and strategies for improving segmentation practices in radiology and radiation oncology are discussed, as are potential pitfalls to avoid. Key Points: As AI continues to advance, volumetry will become more integrated into clinical practice, making it essential for radiologists to stay informed about its applications in diagnosis and treatment planning. There is a significant lack of practical guidelines and resources tailored specifically for radiologists on technical topics like segmentation and volumetric analysis. Establishing clear rules and best practices for segmentation can streamline volumetric assessment in clinical settings, making it easier to manage and leading to more accurate decision-making for patient care.</p
Confidence Intervals and Sample Size for the ICC in Two-Way ANOVA Models
No full textThe reliability of measurement instruments is vital in fields like medicine and psychology, where these tools are often used for diagnostic purposes. In reliability studies where participants are assessed by the same set of raters, the data can be modeled using a two-way ANOVA, with the intraclass correlation coefficient (ICC) as a key metric. This paper focuses on the ICC for agreement, which is crucial when the measurement values themselves, rather than just their rank ordering, are of interest. However, selecting appropriate confidence interval methods and determining adequate sample sizes for the ICC for agreement remains challenging. This work advances the understanding of confidence interval methods for the ICC for agreement, provides practical tools, and offers recommendations for selecting confidence interval methods and sample size procedures for planning reliability studies. In particular, we provide a comprehensive review and simulation-based comparison of six classes of confidence interval methods for the ICC for agreement identified in the literature. Our analysis includes a method based on the F-distribution, previously omitted, which demonstrates the best statistical properties in some cases. Then, in conjunction with the best-performing methods, we evaluate three sample size determination procedures based on the expected width of confidence intervals that we identified in the literature. To address the lack of accessible tools, we further developed an interactive R Shiny app, freely available to researchers, to compute confidence intervals and sample sizes. The utility of these methods is illustrated by a study on fetal heart rates
13. Trigeminal Neuralgia
No full textIntroduction: Trigeminal neuralgia (TN) is a disorder characterized by recurrent, unilateral brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more branches of the trigeminal nerve, and triggered by innocuous stimuli. Methods: The literature on the diagnosis and treatment of TN was retrieved and summarized. Results: The diagnosis is made almost entirely based on the patient's history. In classical TN, the neurological examination is typically normal, whereas the exam in secondary TN is focused on surveilling for signs of multiple sclerosis (MS) or a cerebellopontine tumor. The appropriate imaging technique is magnetic resonance imaging (MRI) with contrast of the trigeminal ganglion, which is recommended prior to interventional procedures. The treatment of a patient with TN is a team effort and should always be multidisciplinary, addressing all dimensions of pain. Carbamazepine or oxcarbazepine are first-line medical treatments. Microvascular decompression (MVD) is the technique of choice for patients without or with minor comorbidities. Percutaneous procedures for TN are mainly radiofrequency thermocoagulation of the branches of the trigeminal nerve introduced by Sweet and Wepsic in 1965, retrogasserian glycerol injection introduced by Hakanson in 1981, and balloon compression introduced by Mullan and Lichtor in 1983. Radiofrequency treatment is recommended in elderly patients or those with major comorbidities. Other techniques such as stereotactic radiosurgery and pulsed radiofrequency treatment are also discussed. Conclusions: Recommendations are based on very low-quality evidence. MVD and radiofrequency are the preferred invasive treatments, although higher-quality evidence is necessary to better assess the risk–benefit ratios
Cone-beam versus photon-counting detector CT:Influence of dose variations on the detection of simulated mandibular osseous lesions
No full textThis study compared cone-beam computed tomography (CBCT) and photon-counting detector computed tomography (PCD-CT) for detecting simulated mandibular osseous lesions, emphasizing lesion detectability, quantitative accuracy, and inter-reader reliability at equivalent radiation doses. Three types of simulated osseous lesions (sequestrum/fracture, cystic lesion, and extended periodontal gap) were evaluated by two readers, across three radiation dose levels: high (360 μSv), standard (122 μSv), and low (20 μSv). Image quality, artifact presence, and lesion detectability were qualitatively evaluated using a 5-point Likert scale (5 = highest to 1 = lowest rating). Lesion dimensions were quantitatively measured. Statistical analysis included descriptive statistics and weighted kappa for interobserver reliability. High-dose PCD-CT consistently provided the highest image quality, lesion detectability, and minimal artifacts across all lesion types (5 ± 0), achieving perfect inter-reader agreement (100 %). PCD-CT outperformed CBCT in lesion detectability, with the greatest difference at lower doses (3.87 ± 0.35 to 4.83 ± 0.39 vs. 3.13 ± 0.53 to 4.5 ± 0.52). PCD-CT demonstrated superior inter-reader reliability, with perfect agreement for high-dose (κ = 1.0; p < 0.001) and good agreement for standard- and low-dose protocols (κ = 0.909 and κ = 0.744; p < 0.001). Quantitative measurements showed minimal intermodal differences ranging from 0.15 to 0.34 mm, confirming PCD-CT's clinical precision even at low-dose protocols. These findings highlight PCD-CT's potential in dentomaxillofacial imaging, enhancing diagnostic capabilities and reducing radiation exposure.</p
Democracy and the rights of representation in the case law of the European Court of Human Rights
No full textThis chapter examines the case law of the European Court of Human Rights on the rights of representation and discusses its potential in supporting a representative model of democracy in the times when many states are backsliding. It demonstrates that the Court’s protective approach to the rights of representation contributes to making democracies in the Council of Europe Member States more transparent and their institutions more accountable. However, it also shows that the right to vote and stand for election is protected to a lesser degree than some other political rights, such as freedom of expression and assembly due to the wording of Article 3 of Protocol 1 ECHR and the wide margin of appreciation that is afforded to the states in this regard. This means that the Court can provide a mechanism of last resort in situations of manifest breach, but it is ultimately for the national authorities to ensure the overall functioning of an efficient, transparent and accountable representative democracy. At the same time, national and international supervision must remain in a mutually reinforcing relationship
Innovation and Structural Transformation in Asia
No full textThis book explores recent drivers of Asia’s growth and economic development. The analysis is based on a database created by the authors. It covers a large number of economies, including 39 from Asia for the period 1990–2020. The database and the analysis in the book use novel indicators of development. It is structured along four areas: productivity and structural change, global value chains (GVCs), economic complexity, and the Fourth Industrial Revolution (4IR). The book offers insights into current economic performance and future prospects. It shows great heterogeneity across the region, highlighting a range of development experiences. Each chapter contains an accessible methodological section of the concepts used, explaining the construction of indicators and how they should be interpreted. The book will interest scholars of Asian economics, structural transformation, productivity, GVCs, complexity, and 4IR studies. The publicly available database will also appeal to policymakers and researchers interested in data analysis