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In the Eye of the Beholder:Visualizing Strengths, Burdens and Desires Through the Lens of Neurodivergent Children, Their Parents, and Professionals Using the Yucel Method
No full textObjectivesIn mental healthcare, there is a growing emphasis on one's strengths and context instead of focusing primarily on individual deficiencies, pathologies, risks, and negative emotions. Using the visual and tactile Yucel method, this study gains insight into strengths, burdens, and desires of neurodivergent children in residential care and their parents from different perspectives.MethodsIn this qualitative study, a total of 45 interviews with the Yucel method were conducted with nine neurodivergent children, their parents, and involved professionals. All built a constellation of the child and family's strengths, burdens, and desires using the Yucel method. To explore if by applying this visual and tactile method additional information is provided to that gathered in the standard diagnostic process, the information of the Yucel method was compared to the information found in the multidisciplinary reports of the children.ResultsThematic analysis showed that besides common mentioned strengths (e.g., mother, sports and activities) and burdens (mental health problems), differences in the informants' perspectives were found. Parents mentioned strengths and burdens that were not addressed by other informants and a diversity in needs was found. The comparison of the results from the interviews with the Yucel method with the information in the multidisciplinary reports showed that the Yucel method provided additional information.ConclusionsThe Yucel method brought more strengths and perspectives into view than diagnostics as usual in the first three months of residential care. This study contributes to the knowledge regarding personal, strength-based, and family-oriented diagnostics in mental healthcare of neurodivergent children and their families
Introduction of a nationwide first-trimester anomaly scan in the Dutch national screening program
No full textBackground: A significant proportion of major fetal structural anomalies can be detected in the first trimester by ultrasound examination. However, the test performance of the first-trimester anomaly scan performed in a low-risk population as part of a nationwide prenatal screening program is unknown. Potential benefits of the first-trimester anomaly scan include early detection of fetal anomalies, providing parents with more time for reproductive decision-making. Objective: To investigate the uptake, test performance, and time to a final prenatal diagnosis after referral. Study Design: A nationwide implementation study was conducted in the Netherlands (November 2021−November 2022). The FTAS was performed between 12+3 and 14+3 weeks of gestation by certified sonographers using a standard protocol. Women were referred to a tertiary care center if anomalies were suspected. Uptake, test performance, and time to a final prenatal diagnosis (days between referral and date of final diagnosis/prognosis for reproductive decision-making) were determined. Test performance was calculated for first-trimester major congenital anomalies, such as anencephaly and holoprosencephaly and all diagnosed anomalies <24 weeks of gestation. Results: The first-trimester anomaly scan uptake was 74.9% (129,704/173,129). In 1.0% (1313/129,704), an anomaly was suspected, of which 54.9% (n=721) had abnormal findings on the detailed first-trimester diagnostic scan and 44.6% (n=586) showed normal results. In 0.5% (n=6), intrauterine fetal death occurred. In the total group of 721 cases with abnormal findings, 332 structural anomalies, 117 genetic anomalies, 82 other findings (abnormal fetal biometry, sonomarkers, placental/umbilical cord anomaly, an-/oligohydramnios), and 189 cases with transient findings (defined as ultrasound findings which resolved <24 weeks of gestation) were found, with 1 case having an unknown outcome. 0.9% (n=1164) of all cases with a normal first-trimester anomaly scan were diagnosed with a fetal anomaly in the second trimester. Test performance included a sensitivity of 84.6% (126/149) for first-trimester major congenital anomalies and 31.6% (537/1701) for all types of anomalies. Specificity for all anomalies was 99.2% (98,055/98,830); positive predictive value 40.9% (537/1312); negative predictive value 98.8% (98,055/99,219); positive likelihood ratio 40.3; negative likelihood ratio 0.7; false positive rate 0.8% (775/98,830), and false negative rate 68.4% (1164/1701). The median time to diagnosis for structural anomalies was 20 days (6–43 days; median gestational age 16+3), for genetic anomalies 17 days (8.5–27.5 days; median gestational age 15+6 weeks), and for first-trimester major congenital anomalies 9 days (5–22 days; median gestational age 14+6 weeks). Conclusion: The performance of a newly introduced nationwide first-trimester anomaly scan in a low-risk population showed a high sensitivity for first-trimester major congenital anomalies and a lower sensitivity for all anomalies combined. The program was accompanied by a referral rate of 1.0%, of which 59.1% involved cases where anomalies were either not confirmed or resolved before 24 weeks gestation. Timing of diagnosis was around 16 weeks of gestation for referred cases. To evaluate the balance between benefits and potential harm of the first-trimester anomaly scan within a nationwide prenatal screening program, it is essential to assess the effectiveness of the program over time and to consider the perspectives of both women and their partners, as well as healthcare professionals.</p
Worldwide application and valuation of extracorporeal membrane oxygenation support during the COVID-19 pandemic (WAVES)
No full textOBJECTIVE: The outcomes of COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) varied. We aim to investigate the variability concerning location and timeframe. We conducted a retrospective analysis of data from 351 institutions in 53 countries. The primary outcome was survival to hospital discharge or death up to 90 days from ECMO start. The associations between calendar time (month and year) of ECMO initiation and the primary outcome were examined by Cox regression modeling. Multivariable survival analyses were adjusted for the time of ECMO start, age, body mass index, APACHE II, SOFA, and the duration of mechanical ventilation before ECMO. RESULTS: 1060 adult COVID-19 patients enrolled in the COVID-19 Critical Care Consortium (COVID Critical) international registry and required VV-ECMO support. The study period is from January 2020 to December 2021. The median age was 51 years old, and 70% were male patients. Most patients were from Europe (39.3%) and North America (37.4%). The in-hospital mortality of the entire cohort was 47.12%. In North America and Europe, there was an increased probability of death from May 2020 through February 2021. Latin America showed a steady rate of survival until late in the study. South Asia, the Middle East, and Africa showed an increased chance of mortality around May 2020. In the Asian-Pacific region, after February 2021, there was an increased probability of death. The time of ECMO initiation and advanced patient age were associated with increased mortality. CONCLUSION: Variability in the outcomes of COVID-19 patients on VV-ECMO existed within different regions. This variability reflects the differences in resources, policies, patient selection, management, and possibly COVID-19 virus subtypes. Our findings might help guide global response in the future by early adoption of patient selection protocols, worldwide policies, and delivery of resources
Touch Helps Hearing:Evidence From Continuous Audio-Tactile Stimulation
No full textOBJECTIVES: Identifying target sounds in challenging environments is crucial for daily experiences. It is important to note that it can be enhanced by nonauditory stimuli, for example, through lip-reading in an ongoing conversation. However, how tactile stimuli affect auditory processing is still relatively unclear. Recent studies have shown that brief tactile stimuli can reliably facilitate auditory perception, while studies using longer-lasting audio-tactile stimulation yielded conflicting results. This study aimed to investigate the impact of ongoing pulsating tactile stimulation on basic auditory processing. DESIGN: In experiment 1, the electroencephalogram (EEG) was recorded while 24 participants performed a loudness-discrimination task on a 4-Hz modulated tone-in-noise and received either in-phase, anti-phase, or no 4-Hz electrotactile stimulation above the median nerve. In experiment 2, another 24 participants were presented with the same tactile stimulation as before, but performed a tone-in-noise detection task while their selective auditory attention was manipulated. RESULTS: We found that in-phase tactile stimulation enhanced EEG responses to the tone, whereas anti-phase tactile stimulation suppressed these responses. No corresponding tactile effects on loudness-discrimination performance were observed in experiment 1. Using a yes/no paradigm in experiment 2, we found that in-phase tactile stimulation, but not anti-phase tactile stimulation, improved detection thresholds. Selective attention also improved thresholds but did not modulate the observed benefit from in-phase tactile stimulation. CONCLUSIONS: Our study highlights that ongoing in-phase tactile input can enhance basic auditory processing as reflected in scalp EEG and detection thresholds. This might have implications for the development of hearing enhancement technologies and interventions
Constructing Chinese Firms as Development Catalysts:State-Firm Public Diplomacy Collaboration in Kenya
No full textThe debate surrounding China's public diplomacy in Africa highlights how the state coordinates and leverages Chinese actors, including firms, to advance diplomatic objectives. However, this article questions the notion of unidirectional state dominance by exploring the intricate interactions between the Chinese state and firms around promoting and publicizing corporate social responsibility (CSR), which is conceptualized as a public diplomacy tool of corporations to engage with the foreign public. Using the lens of public diplomacy, the author examines the unconventional state-firm interplay in the symbolic domain, shedding light on practices of China's expansion in Africa. Through two empirical cases, the author demonstrates the interdependence and collaboration between the Chinese state and firms, revealing their divided interests and contested cooperative efforts to enact public diplomacy in Kenya
New IPECAD Open-Source Model Framework for the Health Technology Assessment of Early Alzheimer's Disease Treatment:Development and Use Cases
No full textObjectives: Reimbursement decisions for new Alzheimer's disease (AD) treatments are informed by economic evaluations. An open-source model with intuitive structure for model cross-validation can support the transparency and credibility of such evaluations. We describe the new model framework (version 2) for the health-economic evaluation of early AD treatment and use it for cross-validation and addressing uncertainty. Methods: A cohort state-transition model using a categorized composite domain (cognition and function) was developed by replicating an existing reference model and testing it for internal validity. Then, features of existing Institute for Clinical and Economic Review (ICER) and lecanemab treatment were implemented for model cross-validation. Additional uncertainty scenarios were performed on choice of efficacy outcome from trial, natural disease progression, treatment effect waning and stopping rules, and other methodological choices. The model is available open-source as R code, spreadsheet, and web-based version via https://github.com/ Results: In the IPECAD model incremental life-years, quality-adjusted life-years (QALY) gains and cost savings were 21% to 31% smaller compared with the ICER model and 36% to 56% smaller compared with the AD-ACE model. IPECAD model results were particularly sensitive to assumptions on treatment effect waning and stopping rules and choice of efficacy outcome from trail. Conclusions: We demonstrated the ability of a new IPECAD open-source model framework for researchers and decision makers to cross-validate other (Health Technology Assessment submission) models and perform additional uncertainty analyses, setting an example for open science in AD decision modeling and supporting important reimbursement decisions
Reply to:‘Enhancing patient-centered care and addressing psychosocial needs in colorectal cancer: The role of the ABCRC tool’
No full textRelationships among adult full, half, and stepsiblings:Does coresidence explain the stepgap?
No full textObjectiveThis article aims to compare adult sibling ties of stepsiblings to the ties of full and half-siblings in divorced families, widowed families, and single-parent families.BackgroundSiblings are one of the most stable sources of attachment and companionship over the life course and function as important providers of practical and emotional support when going through important life transitions. Due to a steep rise in divorce over the past decades and accompanied increases in remarriage and multipartner fertility, many adults nowadays not only have full siblings, but also half-siblings and stepsiblings.MethodUsing a new module on adult sibling relationships and random- and fixed-effects modeling (OKiN, N = 4506 dyads nested in N = 1742 respondents), we examine the quality of full, half, and stepsibling ties in adulthood and test the main mechanisms driving a potential stepgap in sibling ties: (1) the (absence) of a shared genetic relatedness and (2) the amount of time shared in the same parental household.ResultsThe weaker bonds adults, on average, have with their stepsiblings compared to their biological (full and half) siblings are largely explained by the shorter period of time they have lived together during childhood. Nevertheless, a substantial gap remains.ConclusionOur results confirm that a stepgap in sibling closeness, contact, and support is visible, but substantially reduced once shared time is considered
Correction: Diffusion-weighted imaging in addition to contrast-enhanced MRI in identifying complete response in HER2-positive breast cancer (Jul, 10.1007/s00330-024-10857-7, 2024)
No full textIn the Abstract of this article, subsection Results, the sentence beginning with “In HR-negative/HER2-positive breast cancer…” should have been “In HR-positive/HER2-positive breast cancer…”. The correct sentence is: In HR-positive /HER2-positive breast cancer the NPV for DCE MRI differs between MRI field strength (1.5 T: 50% vs. 3 T: 81% (p = 0.02)). Furthermore, in the online version of the article, In Section ‘Endpoints’ the equation for ADCmean is displayed incorrectly due to an error in copyediting. Instead of: (Formula presented.) The correct equation is as follows: (Formula presented.) The original article has been corrected.</p
Joint Trajectories of Performance-Based and Self-Reported Physical Functioning in Older Adults:A 20-Year Longitudinal Study in the Netherlands
No full textBackground: The well-known disablement process has been conceptualized as a series of transitions between progressive states of functional decline. We studied joint patterns of change within disablement states defined as walking speed, grip strength, and self-reported disability. Methods: 1702 participants aged 65 and over were included from the Longitudinal Aging Study Amsterdam, spanning seven waves over 20 years (1996–2016). Group-based multi-trajectory modeling yielded trajectory clusters (TCs) of different patterns of change, further characterized by baseline sociodemographic characteristics, physical and cognitive health, and survival rate. Results: Five TCs were identified, distinguished by increasing baseline age. Walking speed and disability showed generally concomitant trajectories. Women had poorer trajectories in grip strength than men, but not in walking speed and disability. Poor physical health distinguished especially the poorest, and cognitive impairment distinguished especially the one-before-poorest from the better TCs. Discussion: The findings suggest that the disablement states are not generally distinct or sequential