263134 research outputs found
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Pricing GHG emissions in agriculture: Accounting for trade and fairness for effective climate policy
No full textstatus: Accepte
Impact of orthodontic treatment on front teeth with prior history of dental injury: a 4-year follow up
No full textOBJECTIVES: The primary aim of this study is to describe the pulpal outcome of front teeth (definitive upper and lower incisors and canines) with prior injury at start (T1), completion (T2) and follow-up (T3) of orthodontic treatment, analyzing the impact of trauma type, orthodontic appliance and oral habits on the prevalence and severity of root resorption (RR), compared with surrounding front teeth without trauma. Additionally, the influence of upper central incisor extraction on treatment duration, esthetic outcomes and patient satisfaction was investigated. METHODS: Pulpal outcomes at T1, T2 and T3 were compared using Fisher's Exact test. The odds ratio for prevalence and severity of RR of front teeth after orthodontic treatment and its relationship with oral habits were calculated using cumulative logistic regression. The impact of incisor extraction on treatment duration, patient satisfaction and esthetic outcomes was analyzed using Pairwise comparisons. RESULTS: 141 patients were included (79 male, mean age at T1 13.7 ± 5.9 years, mean follow-up 4.7 ± 2.2 years). 51.5% of the injuries involved periodontal damage, 33% involved incisor extraction. Injured front teeth were significantly more prone to pulp necrosis and presented 4 times more RR after orthodontic treatment compared to their non-injured counterparts, independently of the orthodontic appliance used. The longer the orthodontic treatment, the higher the risk for RR. Nail biting and lip interposition led to higher risk of RR, but not tongue thrust. Gingival line and papillary integrity were worse in incisor extraction, although patient satisfaction remained high (> 70%). CONCLUSION AND CLINICAL RELEVANCE: Injured front teeth are more prone to pulpal complications and RR than those without trauma. Long courses of treatment should be avoided, especially in severe injuries. Incisor extraction led to significantly worse gingival esthetic outcomes, although this didn't influence patient satisfaction.status: Publishe
EACTS Expert Consensus Document on protected cardiac surgery: pre-emptive use of temporary mechanical circulatory support in adult cardiac surgery patients at high risk for perioperative low cardiac output syndrome.
No full textPerioperative low cardiac output syndrome (LCOS) remains a significant complication in adult cardiac surgery, contributing to substantial morbidity, prolonged intensive care, and increased mortality. Its incidence is expected to rise further due to the evolving complexity of referred surgical patients, often characterised by advanced age, multiple comorbidities, challenging anatomy, and impaired haemodynamics. Despite advances in pharmacological and perioperative care, outcomes for high-risk patients have not shown significant improvement, prompting interest in temporary mechanical circulatory support (tMCS) as a proactive strategy. This Expert Consensus Document from the European Association for Cardio-Thoracic Surgery (EACTS) presents the first dedicated guidance on the pre-emptive use of tMCS in high-risk adult cardiac surgical patients. Developed by a multidisciplinary task force, it emphasises structured risk stratification, early initiation, and individualised device management informed by interdisciplinary Heart Team discussions. The document proposes clinical pathways for patient selection, defines criteria for tMCS initiation, and provides practical algorithms for various scenarios, including advanced heart failure, cardiogenic shock, and post-cardiotomy LCOS. It reviews the current evidence on available tMCS devices, such as intra-aortic balloon pumps, microaxial flow pumps, veno-arterial extracorporeal life support and hybrid strategies, and addresses perioperative care, ICU protocols, ethical considerations, as well as informed consent and support withdrawal. Despite promising results, substantial knowledge gaps remain, including long-term outcome data, device selection criteria, and cost-effectiveness analyses. This consensus aims to support clinical decision-making, standardise practice, and stimulate research to improve outcomes in a growing population of high-risk surgical patients.status: Published onlin
Het potentieel van tuinbeheer voor klimaatadaptatie: een socio-ecologisch perspectief
No full textCities worldwide are facing escalating challenges of rapid population growth, urbanization, and the intensifying impacts of climate change. As urban areas expand and environmental pressures mount, scaling up adaptation measures through climate-resilient urban planning and design is essential to ensure quality of life for current and future generations. While previous research and policy have predominantly focussed on large-scale and public green infrastructure, one vital component of the urban green and blue network has remained hidden and largely unexplored: private domestic gardens.
Domestic gardens account for 16% to 36% of urban areas worldwide, representing a substantial, though fragmented, share of urban green space. Despite their small individual size and private character, their collective network holds significant potential for climate change adaptation and mitigation by providing various ecosystem services. However, this potential cannot be attributed to their ecological characteristics alone. Gardens are inherently socio-ecological systems where people and nature interact over time and space, shaping the quantity and quality of ecosystem services they provide. Therefore, this dissertation explored the climate change adaptation potential of garden management through a socio-ecological perspective.
Chapter 2 introduces Flanders (Belgium) as the study area, outlining its climatic and spatial context, the characteristics of its garden landscape, and insights from gardeners gathered through interviews and a photo reportage. Although domestic gardens cover a large share of the region and hold considerable potential, their management remains diverse and primarily driven by individual preferences rather than coordinated policy efforts.
In Chapter 3, a systematic review following the ROSES protocol provides an overview of the existing knowledge on small-scale nature-based solutions applicable in domestic gardens for climate change adaptation. The chapter stresses the urgent need for more quantitative research on the range and effectiveness of ecosystem services provided by small-scale nature-based solutions. It also reflects upon the feasibility and practical implications of improving current lawn management practices, reducing soil sealing or pavement, and increasing tree cover in domestic gardens.
Using survey data of 827 garden owners and Structural Equation Modelling, Chapter 4 examines how motivations, knowledge, spatial- and socio-economic factors are associated with specific garden management decisions related to sealed soil, lawns, and tree cover. Our findings show that spatial context, socio-economic status, and personal motivations are more critical in shaping garden management than knowledge alone.
Drawing on survey data of 1,286 garden owners, in Chapter 5, multiple ordinal regressions and correlation analyses are applied to examine how household and parcel characteristics affect garden use, garden composition, and residents' willingness and barriers to making changes. Flemish gardens are mainly used for relaxation and enjoying the view. Although household and parcel characteristics influence garden use, no strong link was found between use and composition, suggesting that garden compositions can be improved without altering their function. While most residents are willing to adapt their gardens, they still face multiple barriers. A comparison with Greater Manchester (UK) further highlights the need for region-specific support.
Chapter 6 evaluates the impact of two citizen science initiatives aiming to promote more sustainable lawn management. The initiatives differed in participation barriers, required effort, and level of involvement in research. Using pre- and post-intervention surveys over three years, the study assessed changes in both psychological factors and lawn management practices. Both initiatives increased awareness, reduced personal norms regarding garden neatness, and encouraged behavioural change, resulting in reduced mowing, smaller areas of short-cut lawn, and more species-rich grassland.
In summary, this dissertation improved our understanding of the climate change adaptation and mitigation potential of domestic gardens. It not only advances the theoretical understanding of gardens as socio-ecological systems but also offers actionable insights for urban planning and behaviourally informed policy development. Effective strategies must acknowledge the need for a cultural shift in garden management, should be tailored to the spatial context, and should consider socio-economic variations. Building on these findings, the dissertation also outlines practical policy guidance using the 7E-model of social marketing to support maximizing the climate change adaptation potential of garden management.status: Publishe
Rethinking (un)blinding in biomedical proposal peer review: A multi-stakeholder qualitative study
No full textBACKGROUND: Many peer review attributes are widely criticized and poorly investigated, particularly in the context of proposals' peer review. This study aims to explore stakeholders' perspectives on the role of (un)blinding and the implications of open peer review for biomedical proposals' peer review. METHODS: We conducted a generic descriptive qualitative study within a constructivist paradigm, using semi-structured interviews. Twenty-three participants were selected through purposive and snowball sampling from funding agencies in Belgium and Qatar. Transcribed interviews were analyzed according to the 6-step thematic framework analysis. During the interviews, participants were asked to rate 7 quantitative statements to supplement the qualitative data. RESULTS: Codes with shared characteristics were grouped into categories, and ultimately three themes were generated: (1) the importance of increased transparency in fund allocation procedures while maintaining blinded reviewers' identities, (2) open peer review as a feasible approach for enhancing transparency and accountability in proposals' peer review, and (3) a growing critical stance toward traditional peer review systems. CONCLUSION: While there remains a strong preference for double-blinded review within the context of our study, its limitations have become evident-particularly given current funding challenges. These shortcomings highlight the need for greater openness in peer review and increased transparency in fund allocation processes.sponsorship: Open Access funding provided by the Qatar National Library. (Qatar National Library)status: Published onlin
Almost real closed fields with real analytic structure
No full textsponsorship: Author F.V. was supported by F.W.O. Flanders (Belgium) with grant number 11F1921N. Author K.H.N was supported by F.W.O. Flanders (Belgium) with grant number 1270923N. Author M.S. was part of, and supported by KU Leuven during this project and is currently supported by McMaster University and the Fields Institute. (F.W.O. Flanders (Belgium)|11F1921N, F.W.O. Flanders (Belgium)|1270923N, KU Leuven, McMaster University, Fields Institute)status: Published onlin
Biomechanics of Manual-Bent Versus Patient-Specific Mandibular Implants
No full textThe patient-specific mandibular reconstruction plate (PSMRP) has gained prominence for its precise adaptation to mandibular contours and reported enhanced mechanical reliability compared to the manual-bent mandibular reconstruction plate (MBMRP). Despite this, a biomechanical comparison between MBMRP and PSMRP is essential for informed clinical decision-making and advancing the field of mandibular reconstruction. Thereupon, biomechanical behavior was compared between two reconstructed mandibles with the MBMRP made of commercial pure titanium plate and the PSMRP stemmed from a common ramus reconstruction case, respectively, in physiological simulation using finite element analyses. Results reveal that the PSMRP presents greater safety and better stability to the reconstructed mandible than the MBMRP in the physiological situation, indicated by over 45% lower peak equivalent von Mises stress and more than 35% less maximum displacement.status: Publishe
Recurrence detection in head and neck cancer: a systematic review of routine follow-up practices and clinical implications
No full textAbstract
Introduction
Worldwide, Head and Neck Cancer (HNC) follow-up guidelines are mostly consensus-based. The benefits of routine follow-up for early recurrence detection remain disputed. This systematic review examines recurrence detection and further management.
Methods
PubMed, EMBASE, The Cochrane Library and Web of Science were searched for studies on recurrence diagnosis and management after curative-intent treatment of a primary carcinoma of the most common head and neck sites. Bias was assessed using the Risk of Bias In Non-randomised Studies of Interventions tool. Key outcomes included recurrence characteristics (frequency, localization, primary tumor stage), time to recurrence, diagnosis during routine or extra visits, symptoms, treatment intent and success, and survival.
Results
A total of 48 studies were included: 12 were at moderate, and 36 at serious risk of bias. Fifteen studies reported that between 59 % and 100 % (mean: 77 %) of recurrences were diagnosed within two years posttreatment. The majority (mean: 72 %) were symptomatic. More than half were diagnosed at patient-initiated follow-up visits. No significant survival differences were found between symptomatic and asymptomatic patients or between recurrences diagnosed during routine versus extra visits.
Conclusions
Routine follow-up beyond two years for detecting asymptomatic recurrences is unlikely to significantly improve early diagnosis or survival. Potential downsides include anxiety prior to visits, societal costs, and burden on healthcare systems and ecosystems. Limiting routine follow-up to two years can be considered unless patients cannot be educated on recurrence-related symptoms. Ensuring accessible care in case of needs or symptoms is crucial.status: Published onlin
Pain management after hallux valgus repair surgery: an updated systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations
No full textBACKGROUND: Hallux valgus repair surgery is associated with moderate-to-severe postoperative pain. The aim of this systematic review was to assess the available literature and update previous PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations for optimal pain management after hallux valgus repair surgery. METHODS: A systematic review utilising PROSPECT methodology was performed. Randomised controlled trials and systematic reviews published in the English language from January 1, 2019 to November 19, 2024 that assessed postoperative pain using analgesic, anaesthetic and surgical interventions were identified from CENTRAL, CINAHL, EMBASE, MEDLINE and Web of Science. RESULTS: Of the 375 articles identified, 17 RCTs and 7 systematic reviews/meta-analyses met our inclusion criteria (total: 24 publications). Interventions that improved postoperative pain relief included: paracetamol and nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 selective inhibitors; dexamethasone; ankle block and, as an alternative, local anaesthetic wound infiltration; and minimally invasive surgery or percutaneous osteotomy. Insufficient evidence was found for the use of perineural magnesium or liposomal bupivacaine. No evidence was found for continuous popliteal sciatic nerve block or for the use of the plantar compartment nerve block. DISCUSSION: This review provides an update to the previous guidelines written by the PROSPECT group: there is one important change, minimally invasive surgery or percutaneous osteotomy is recommended over open osteotomy. Contemporary publications confirm the analgesic effects of ankle block as a first-choice modality with wound infiltration as an alternative. In addition, the analgesic regimen for hallux valgus repair should include, in the absence of contraindication, paracetamol and a nonsteroidal anti-inflammatory drug or cyclooxygenase-2 selective inhibitor administered preoperatively or intra-operatively and continued postoperatively, along with systemic dexamethasone, and postoperative opioids for rescue analgesia.sponsorship: PROSPECT is supported by an unrestricted grant from the European Society of Regional Anaesthesia and Pain Therapy (ESRA) (European Society of Regional Anaesthesia and Pain Therapy (ESRA))status: Accepte
Phase 3 clinical trials evaluating poly(ADP-ribose) polymerase inhibition plus immunotherapy for first-line treatment of advanced ovarian cancer
No full textBACKGROUND: Ovarian cancer is the second deadliest gynecologic malignancy globally. The current standard of care first-line therapy for newly diagnosed advanced epithelial ovarian cancer is surgery and platinum-based chemotherapy (±bevacizumab), followed by maintenance therapy with a poly(ADP-ribose) polymerase (PARP) inhibitor, bevacizumab, or a combination of the two. Although anti-programmed cell death (PD) protein 1 and anti-PD ligand 1 antibodies (PD-[L]1 inhibitors) have shown benefit in several solid tumors, their effect in ovarian cancer remains uncertain. Several trials are evaluating PD-(L)1 inhibitors in combination with first-line platinum-based chemotherapy and PARP inhibitor maintenance treatment. Here, we review trial designs to understand key similarities and differences for future assessments of the results. MATERIALS AND METHODS: The clinical trials registry "ClinicalTrials.gov" was searched using keywords, including ovarian cancer and niraparib, olaparib, or rucaparib. Search results were then filtered for phase 3 and manually reviewed to identify trials evaluating combinations of PARP inhibitors and PD-(L)1 inhibitors in the first-line setting. RESULTS: Four trials, ENGOT-OV44/FIRST (NCT03602859), ENGOT-OV46/AGO-OVAR 23/GOG-3025/DUO-O (NCT03737643), ENGOT-OV43/GOG-3036/KEYLYNK-001 (NCT03740165), and ENGOT-OV45/GOG-3020/ATHENA (NCT03522246), were identified. Of these, FIRST, DUO-O, and KEYLYNK-001 are evaluating both first-line use in combination with chemotherapy and maintenance, whereas ATHENA focuses on maintenance after a response to chemotherapy; however, DUO-O and KEYLYNK-001 do not include a PARP inhibitor in the comparator arm, limiting the ability to compare the added benefit of immunotherapy over the current standard of care. CONCLUSIONS: Results of these trials will determine whether PARP inhibitor and PD-(L)1 inhibitor combination with or without bevacizumab can improve patient outcomes.sponsorship: Medical writing and editorial support for the development of this manuscript, under the direction of the authors, were funded by GSK; coordinated by Ingrid Leal, MD, of GSK; and provided by Jessica M. Weems, PhD, CMPP, Ritu Pathak, PhD, and Mary C. Wiggin of Ashfield MedComms, an Inizio company. (GSK)status: Publishe