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Ablation of cavo-tricuspid isthmus dependent atrial flutter using a focal monopolar pulsed-field ablation catheter:Feasibility, periprocedural coronary spasms and conduction disorders
No full textBackground: Pulsed-field ablation for the treatment of cavotricuspid isthmus (CTI)–dependent atrial flutter has been associated with coronary spasms (CS) and atrioventricular conduction disorders (CD). Objectives: The purpose of this study was to evaluate the feasibility of CTI ablation using a monopolar focal pulsed-field ablation (F-PFA) catheter and to assess the risk of CS and CD during and after the procedure. Methods: We prospectively enrolled patients with atrial flutter treated with an F-PFA system (CardioFocus, Marlborough, MA) or by focal radiofrequency ablation (RFA) using contact force–sensing catheters integrated into electroanatomic mapping systems. Intravenous nitroglycerin was administered prior to F-PFA. Feasibility and safety with a focus on CS or CD were assessed. In a subgroup of patients, the course of the right coronary artery and the His position were determined. Results: In total, 82 patients underwent CTI ablation with F-PFA (mean age 66 ± 8 years; 15 (18%) being female; CHA 2DS 2-VA score 1.6 ± 1.3) and 27 patients underwent CTI ablation with RFA (mean age 63 ± 9 years; 4 (23%) being female; CHA 2DS 2-VA score 2 ± 1.3). For F-PFA, the rate of first-pass block was higher (93% vs 55%) and the median (interquartile range) procedure times were shorter (7 [5–11] minutes vs 17 [15–19] minutes) than for RFA. In the F-PFA group, 4 patients (5%) had transient ST-segment elevation and 2 patients (2%) had transient complete atrioventricular block during ablation. There was a small but significant prolongation of the PQ interval after CTI ablation in the F-PFA group. Conclusion: CTI ablation using F-PFA is feasible, but operators should be aware of rare but critical CD and CS during the procedure, even when preventive measures such as nitroglycerin administration are used.</p
The impact of a telepresence robot on group conditions and student engagement:A mixed-method study in higher education
No full textDrawing on team learning theory, this paper examines whether and how a telepresence robot impacts group conditions and student engagement among graduate students collaborating within a hybrid classroom. Hybrid classrooms face challenges, such as an asymmetry of presence, compromising collaborative learning between remote and on-site students. A field experiment was conducted with 17 hybrid classrooms across two Master of Science courses. In the eight experimental groups, one remote student joined via a telepresence robot, while any additional remote students in the same group participated via the smart screen. In the nine control groups, all remote students participated solely via the smart screen. Analysis of short-term longitudinal survey data from 156 students indicated that students in experimental groups with a telepresence robot reported higher levels of social cohesion, psychological safety and group potency, especially in the early course stages. These group conditions positively influenced student engagement. Interviews with ten on-site students reveal that the telepresence robot enhanced remote students' presence through physical embodiment and fostered empowerment via autonomous mobility. This reduced presence asymmetry facilitated more natural interactions, reinforcing group conditions: social cohesion through interpersonal connections, psychological safety through reduced participation barriers, and group potency through increased knowledge sharing. The telepresence robot also fostered inclusive behavior among on-site students, driven by their reciprocation of remote students' engagement and recognition of them as valuable contributors to collaborative learning. These findings advance understanding of team learning and the role of telepresence robots in hybrid classroom settings, promoting more effective virtual inclusion for remote students
Investigating How Age Affects Self-Perception and Voice Awareness in Parkinson's Disease
No full textOBJECTIVE: Parkinson's disease (PD) presents with voice disturbances accompanied by sensory processing and awareness deficits. Sensory feedback from the voice, which is essential in speech production, is often impaired in individuals with PD (IwPD), potentially leading to such difficulties in the self-perception and awareness of voice disorder. However, aging naturally affects sensory and motor brain systems, including those involved in voice production; therefore, it remains unclear whether the combined effects of age and PD exacerbate deficits in voice self-perception and awareness deficit. This study explored how age and sensory feedback in IwPD interact and affect self-perception and awareness of voice changes. Patient-reported outcome measures (PROMs) specific to the voice may not be efficient enough to capture voice changes in IwPD. METHODS: The study included three groups of similar ages: 27 IwPD (61-79 years), 25 individuals with general voice disorders (GVD, aged 57-83 years), and 28 healthy controls (HC, aged 60-80 years). Self-perception of the voice was assessed by three PROMs: the Voice Symptoms Scale, Voice Handicap Index-10, and Voice-Related Quality of Life. Voice loudness was recorded and analyzed using univariate comparisons between the PROM scores. Further, multivariate techniques, such as principal component analysis (PCA) and cluster analysis, were used to identify intergroup differences in voice quality and voice self-awareness. RESULTS: The IwPD group showed lower self-perception and awareness of voice problems than the GVD and HC groups. Within the IwPD group, age did not show a significant impact on self-perception of voice and awareness. This group showed slightly higher PROM scores than the HCs. In contrast, the GVD group showed marked differences in all PROMs and voice parameters compared with the HC and PD groups. PCA revealed significant differences in total scores and voice loudness between the groups. CONCLUSIONS: These findings suggest that age-related changes in sensory feedback are not significant factors affecting reduced self-perception and awareness of voice changes in IwPD. PCA and cluster analysis revealed distinct patterns among the groups, with GVD forming a separate cluster and IwPD displaying variability, partially overlapping with HC and GVD. This variability underscores the limited diagnostic utility of PROMs used to identify voice problems in IwPD compared with older individuals without PD, who generally exhibit greater awareness of voice disorders. Future studies should focus on developing tailored PROMs to better capture these challenges in IwPD
Weighing Parenthood Wishes:A Conjoint Analysis of Criteria to Prioritize Infertile Couples for Publicly Funded Fertility Treatment
No full textBackground: Parenthood is a key life goal for many, but infertility affects about 1 in 6 globally. While fertility treatments offer solutions, their high costs limit access. Many health systems provide public funding, yet budget constraints prevent fully funded access, often leaving patients with significant out-of-pocket costs. Policy makers face the challenge of prioritizing individuals for publicly funded treatments, but how to do this remains unclear and underresearched. Worldwide, funding policies vary widely, often adopting controversial access criteria. Methods: We investigated Belgian population preferences for prioritizing in vitro fertilization (IVF) funding through a discrete-choice experiment with a representative sample of 3,000 Belgians. Attributes included maternal and partner age, infertility cause, civil status, prior biological children, and treatment cost. Using a Bayesian D-optimal design and panel mixed logit model, we assessed criteria relevance. The resulting multiattribute utility function created a priority ranking of couples, which we compared to the ranking under the current Belgian policy, which focuses only on maternal age (&lt;43 y). Results: Analysis of 29,670 prioritization choices identified maternal age, infertility cause, and prior biological children as key criteria. Maternal age of 35 y was prioritized highest, age 25 y as high as 40 y, followed by declining priority until 55 y. Biomedical malfunctions were prioritized over same-sex relationships or unhealthy lifestyles, with the latter prioritized lowest. Having no prior biological children was prioritized categorically higher than having 1, 2, or 3 children, all prioritized equally. Preferences were homogeneous across sociodemographic groups. Conclusions: How to set IVF funding priorities remains a matter of debate. Our study shows that the Belgian population considers multiple criteria beyond maternal age to prioritize couples, calling for further discussion on ethical justifiability and access implications. Highlights: Parenthood is a key life goal to many, but about 1 in 6 are affected by infertility. However, in most countries, public funding for fertility treatment is not provided to everyone who could benefit, and hard choices are inevitable. This study used a discrete-choice experiment in a representative sample of the Belgian population to investigate which criteria should be used for prioritization. Results indicated that maternal age, cause of infertility, and the number of prior biological children were the most significant factors in determining public support for IVF funding. Partner age, civil status of the couple, and cost of IVF treatment were not important. People use multiple criteria to set IVF funding priorities, beyond maternal age (the only criterion used in the current Belgian funding policy). Future research should explore the ethical justifiability and practical implications of using cause of infertility and number of prior children as additional criteria.</p
Van Parkersburg tot Dordrecht: Juridische ontwikkelingen en uitdagingen inzake PFAS
No full textIn deze bijdrage volgen we het juridische PFAS-spoor, van Parkersburg, West Virginia, tot Dordrecht. We beginnen in de Verenigde Staten omdat Nederlandse rechtszaken, onder andere, bouwen op rechtszaken die daar sinds eind jaren negentig door advocaat Rob Bilott worden gevoerd. We lichten toe wat PFAS zijn en waarom PFAS een probleem zijn, en beschrijven enkele juridische ontwikkelingen en uitdagingen in het bestuurs-, civiel en strafrecht
To teach or not to teach? Preferences for working conditions and the alternative career opportunities of pre-service teachers
No full textIn response to the critical shortage of teachers, this study examines the determinants of pre-service teachers' career preferences. We answer the call for more theoretical diversity by employing expected utility theory to identify gaps in earlier literature. Subsequently, we design discrete choice experiments to rigorously quantify Flemish pre-service teachers' preferences and measure beliefs concerning various working conditions in the teaching field compared to alternative careers. Our findings reveal that salary, workload and career opportunities are at least as important to the average pre-service teachers as being able to work with children. Additionally, the best-performing pre-service teachers particularly value career advancement opportunities and curricular autonomy. Accountability policies that reduce teachers' curricular autonomy could therefore harm educational quality by reducing the supply of high-quality teachers. Finally, pre-service teachers' perceptions of working conditions as a teacher are highly heterogeneous, and this heterogeneity plays a decisive role in their career preferences
ToF-SIMS reference spectra of perfluorosulfonic acids in both polarities
No full textPerfluorosulfonic acids (PFSAs) are chemical compounds of the formula CnF(2n + 1)SO3H. PFSAs with six or more perfluorinated carbon atoms are referred to as long chain. These chemical compounds belong to the family of per- and polyfluoroalkyl substances, also known as so-called forever chemicals. Reference spectra in both polarities are presented of the potassium salts of one long-chain perfluorosulfonic acid, namely, perfluorooctanesulfonic acid with an eight-carbon fluorocarbon chain, and one short-chain perfluorosulfonic acid, namely, perfluorobutanesulfonic acid with a four-carbon fluorocarbon chain
