Objective To determine the diagnostic yield of repeated screening for atrial fibrillation(AF)among geriatric patients.Methods A pragmatic prospective cohort study into applying opportunistic screening for AF with a ha...Objective To determine the diagnostic yield of repeated screening for atrial fibrillation(AF)among geriatric patients.Methods A pragmatic prospective cohort study into applying opportunistic screening for AF with a handheld single lead ECG device(SLD)in a geriatric cohort.Consecutive patients of 65 years old and older visiting the geriatric outpatient clinic were eligible for inclusion.A 12 lead ECG was performed,followed by measurements with the SLD during every visit to the geriatric outpatient clinic.A frailty index was based on the accumulation of deficits model.Results 478 patients were eligible.Patients were excluded if they did not give informed consent(17 patients),had a pacemaker or implantable cardioverter defibrillator(20 patients),or had incomplete medical files(two patients).After exclusion,439 patients participated in this study.The mean age was 78 years(range 65 to 100 years),54%were female.AF was known in 89 patients(20%),first detected on the baseline ECG in four patients(1%)and first detected with the SLD in 20 patients(5%)during follow up visits.Sensitivity of the SLD was 90.0%,specificity 99.0%,negative predictive value 99.7%,and positive predictive value 73.5%.Most patients(82%)with AF were frail and 53%were severely frail.Conclusion Repeated screening in geriatric patients has a five times higher diagnostic yield than usual care.It was easily combined with usual care.Because of the positive predictive value of 73.5%,it remains necessary to confirm AF with a 12 lead ECG or 24-h Holter monitoring.展开更多
Background: Research indicates that Posttraumatic stress disorder(PTSD) has an extensive impact on family relationships. Nevertheless, there is a dearth of empirically supported interventions addressing family functio...Background: Research indicates that Posttraumatic stress disorder(PTSD) has an extensive impact on family relationships. Nevertheless, there is a dearth of empirically supported interventions addressing family functioning and PTSD. In the Netherlands, it is considered good clinical practice to offer multi-family therapy(MFT) to veteran and refugee families. MFT for traumatized families aims to address the dysfunctional family patterns that have evolved to address the consequences with trauma.Methods: The aim of this study is to generate a common framework for the practical impact and active ingredients of MFT in families confronted with trauma. The Delphi method was used to study the expert opinion of 11 therapists in Dutch expert trauma institutes.Results: The results indicate that MFT is a promising treatment for families dealing with the consequences of trauma. According to experts, positive outcomes include an increased understanding between family members,particularly visible in the de-escalation of conflicts within the family, and improved parenting. One explanation for the effectiveness of MFT with these target groups is its defining feature of therapy with several families.Conclusions: The findings support the importance of considering family relationships and the family context in interventions for traumatized individuals.展开更多
Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number o...Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number of ambulance deployments is increasing.[3,4]Suggested reasons for this growing demand are changes in social support of people,accessibility of healthcare and social facilities,and the aging population.展开更多
Humanitarian action and disaster risk reduction are essential in addressing global vulnerability to disasters and crises.The Sendai Framework for Disaster Risk Reduction 2015–2030(SFDRR),adopted in 2015,has garnered ...Humanitarian action and disaster risk reduction are essential in addressing global vulnerability to disasters and crises.The Sendai Framework for Disaster Risk Reduction 2015–2030(SFDRR),adopted in 2015,has garnered significant attention for its role in fostering disaster risk reduction.The role the SFDRR plays vis-à-vis humanitarian action represents a crucial space where policies,practices,and priorities(could)converge and diverge.Understanding the dynamics of this SFDRRhumanitarian action relationship is essential for advancing both disaster risk reduction and humanitarian goals.This article comprehensively examines this relationship since the adoption of the SFDRR.Employing a multimethod approach,including a systematic literature review,mapping exercise,and expert interviews,the study identified key themes and challenges in integrating the SFDRR within humanitarian action.Findings indicate that while SFDRR references are prevalent in postdisaster discussions,their full integration into humanitarian strategies remains nascent.Notably,advancements in anticipatory humanitarian action represent primary arenas for SFDRR integration within humanitarianism.The role of the International Disaster Response Law in bridging SFDRR and humanitarianism also emerged as an important finding.The study also underscored blurred distinctions between humanitarianism and disaster-related actions,highlighting the limited systemic integration of the SFDRR by traditional humanitarian actors.Moving forward,the study advocates for improved collaboration between humanitarian and disaster management sectors to strengthen disaster prevention,response,and mitigation.By examining the relationship between SFDRR objectives and modern humanitarian practices,this research aims to enhance disaster preparedness,response,and recovery strategies,alongside other crisis management approaches.展开更多
The field of mycology has grown from an underappreciated subset of botany,to a valuable,modern scientific discipline.As this field of study has grown,there have been significant contributions to science,technology,and...The field of mycology has grown from an underappreciated subset of botany,to a valuable,modern scientific discipline.As this field of study has grown,there have been significant contributions to science,technology,and industry,highlighting the value of fungi in the modern era.This paper looks at the current research,along with the existing limitations,and suggests future areas where scientists can focus their efforts,in the field mycology.We show how fungi have become important emerging diseases in medical mycology.We discuss current trends and the potential of fungi in drug and novel compound discovery.We explore the current trends in phylogenomics,its potential,and outcomes and address the question of how phylogenomics can be applied in fungal ecology.In addition,the trends in functional genomics studies of fungi are discussed with their importance in unravelling the intricate mechanisms underlying fungal behaviour,interactions,and adaptations,paving the way for a comprehensive understanding of fungal biology.We look at the current research in building materials,how they can be used as carbon sinks,and how fungi can be used in biocircular economies.The numbers of fungi have always been of great interest and have often been written about and estimates have varied greatly.Thus,we discuss current trends and future research needs in order to obtain more reliable estimates.We address the aspects of machine learning(AI)and how it can be used in mycological research.Plant pathogens are affecting food production systems on a global scale,and as such,we look at the current trends and future research needed in this area,particularly in disease detection.We look at the latest data from High Throughput Sequencing studies and question if we are still gaining new knowledge at the same rate as before.A review of current trends in nanotechnology is provided and its future potential is addressed.The importance of Arbuscular Mycorrhizal Fungi is addressed and future trends are acknowledged.Fungal databases are becoming more and more important,and we therefore provide a review of the current major databases.Edible and medicinal fungi have a huge potential as food and medicines,especially in Asia and their prospects are discussed.Lifestyle changes in fungi(e.g.,from endophytes,to pathogens,and/or saprobes)are also extremely important and a current research trend and are therefore addressed in this special issue of Fungal Diversity.展开更多
Complementing our previous publications, this paper presents the information schema constructs （ISCs） that underpin the programming of specific system manifestation feature （SMF） orientated information management ...Complementing our previous publications, this paper presents the information schema constructs （ISCs） that underpin the programming of specific system manifestation feature （SMF） orientated information management and composing system models. First, we briefly present （1） the general process of pre-embodiment design with SMFs, （2） the procedures of creating genotypes and phenotypes of SMFs, （3） the specific procedure of instantiation of phenotypes of SMFs, and （4） the procedure of system model management and processing. Then, the chunks of information needed for instantiation of phenotypes of SMFs are discussed, and the ISCs designed for instantiation presented. Afterwards, the information management aspects of system modeling are addressed. Methodologically, system modeling involves （1） placement of phenotypes of SMF in the modeling space, （2） combining them towards the desired architecture and operation, （3） assigning values to the parameters and checking the satisfac- tion of constraints, and （4） storing the system model in the SMFs-based warehouse database. The final objective of the reported research is to develop an SMFs-based toolbox to support modeling of cyber-physical systems （CPSs）.展开更多
Several treatment options corresponding to the grade of keratoconus have been established.These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus,and penetrating ker...Several treatment options corresponding to the grade of keratoconus have been established.These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus,and penetrating keratoplasty or deep anterior lamellar keratoplasty for the more advanced cases of keratoconus.Bowman layer transplantation was developed as a procedure for patients with advanced,progressive keratoconus.The technique consists of transplanting an isolated donor Bowman layer into a mid-stromal pocket of a keratoconic cornea resulting in corneal flattening and stabilization against further ectasia.Thus,it aims at corneal stabilization in eyes with advanced keratoconus,and enabling continued contact lens wear for normal visual functionality.By being a sutureless procedure and using an acellular graft,it potentially avoids commonly known suture and graftrelated complications of penetrating or deep anterior lamellar keratoplasty.The treatment seems to be a promising option in the management of advanced keratoconus in order to postpone or prevent a more invasive corneal surgery,while minimizing the risk of complications and allowing less stringent surveillance and less intensive medical therapy.展开更多
Background:To evaluate the efficacy of manual mid-stromal dissection in stabilizing progressive keratoconus.Methods:Surgeries were performed in 16 eyes of 14 patients with progressive keratoconus.All eyes were examine...Background:To evaluate the efficacy of manual mid-stromal dissection in stabilizing progressive keratoconus.Methods:Surgeries were performed in 16 eyes of 14 patients with progressive keratoconus.All eyes were examined before and at 1 day,1 week,1,3,6 and 12 months after surgery,and every 6 months thereafter.Pentacam(simK,Kmax and pachymetry),best corrected visual acuity(BCVA)and subjective refraction were recorded up to the latest follow-up visit(mean follow-up time 6.6±2.4 years).Results:All surgeries were uneventful,and no postoperative complications occurred.Keratometry values(n=15)stabilized in 6/11 eyes(55%)with a preoperative Kmax<60.0 diopter(D),while all eyes>60 D showed continued progression.In 11/15 eyes(73%)pachymetry was unchanged.BCVA with spectacles remained stable in 7/12 eyes(58%)and improved≥2 Snellen lines in 5/12 eyes(42%).BCVA with a contact lens remained stable in 4/9 eyes(44%),improved≥2 Snellen lines in 3/9 eyes(33%)and deteriorated in 2/9 eyes(22%).Conclusions:Manual mid-stromal dissection was effective in 50%of keratoconic corneas with Kmax values<60 D and may be considered in cases ineligible for other interventions such as UV-crosslinking,stromal ring implantation or Bowman layer transplantation.An advantage of the procedure may be that the tissue is unaltered and that no synthetic or biological implant is required.展开更多
文摘Objective To determine the diagnostic yield of repeated screening for atrial fibrillation(AF)among geriatric patients.Methods A pragmatic prospective cohort study into applying opportunistic screening for AF with a handheld single lead ECG device(SLD)in a geriatric cohort.Consecutive patients of 65 years old and older visiting the geriatric outpatient clinic were eligible for inclusion.A 12 lead ECG was performed,followed by measurements with the SLD during every visit to the geriatric outpatient clinic.A frailty index was based on the accumulation of deficits model.Results 478 patients were eligible.Patients were excluded if they did not give informed consent(17 patients),had a pacemaker or implantable cardioverter defibrillator(20 patients),or had incomplete medical files(two patients).After exclusion,439 patients participated in this study.The mean age was 78 years(range 65 to 100 years),54%were female.AF was known in 89 patients(20%),first detected on the baseline ECG in four patients(1%)and first detected with the SLD in 20 patients(5%)during follow up visits.Sensitivity of the SLD was 90.0%,specificity 99.0%,negative predictive value 99.7%,and positive predictive value 73.5%.Most patients(82%)with AF were frail and 53%were severely frail.Conclusion Repeated screening in geriatric patients has a five times higher diagnostic yield than usual care.It was easily combined with usual care.Because of the positive predictive value of 73.5%,it remains necessary to confirm AF with a 12 lead ECG or 24-h Holter monitoring.
基金supported in part by a grant from de Bond van Nederlands Militaire Oorlogs-en dienstslachtoffers(BNMO)
文摘Background: Research indicates that Posttraumatic stress disorder(PTSD) has an extensive impact on family relationships. Nevertheless, there is a dearth of empirically supported interventions addressing family functioning and PTSD. In the Netherlands, it is considered good clinical practice to offer multi-family therapy(MFT) to veteran and refugee families. MFT for traumatized families aims to address the dysfunctional family patterns that have evolved to address the consequences with trauma.Methods: The aim of this study is to generate a common framework for the practical impact and active ingredients of MFT in families confronted with trauma. The Delphi method was used to study the expert opinion of 11 therapists in Dutch expert trauma institutes.Results: The results indicate that MFT is a promising treatment for families dealing with the consequences of trauma. According to experts, positive outcomes include an increased understanding between family members,particularly visible in the de-escalation of conflicts within the family, and improved parenting. One explanation for the effectiveness of MFT with these target groups is its defining feature of therapy with several families.Conclusions: The findings support the importance of considering family relationships and the family context in interventions for traumatized individuals.
文摘Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number of ambulance deployments is increasing.[3,4]Suggested reasons for this growing demand are changes in social support of people,accessibility of healthcare and social facilities,and the aging population.
基金supported by the European Research Council under the Horizon 2020 research and innovation programme(Grant agreement 884139).
文摘Humanitarian action and disaster risk reduction are essential in addressing global vulnerability to disasters and crises.The Sendai Framework for Disaster Risk Reduction 2015–2030(SFDRR),adopted in 2015,has garnered significant attention for its role in fostering disaster risk reduction.The role the SFDRR plays vis-à-vis humanitarian action represents a crucial space where policies,practices,and priorities(could)converge and diverge.Understanding the dynamics of this SFDRRhumanitarian action relationship is essential for advancing both disaster risk reduction and humanitarian goals.This article comprehensively examines this relationship since the adoption of the SFDRR.Employing a multimethod approach,including a systematic literature review,mapping exercise,and expert interviews,the study identified key themes and challenges in integrating the SFDRR within humanitarian action.Findings indicate that while SFDRR references are prevalent in postdisaster discussions,their full integration into humanitarian strategies remains nascent.Notably,advancements in anticipatory humanitarian action represent primary arenas for SFDRR integration within humanitarianism.The role of the International Disaster Response Law in bridging SFDRR and humanitarianism also emerged as an important finding.The study also underscored blurred distinctions between humanitarianism and disaster-related actions,highlighting the limited systemic integration of the SFDRR by traditional humanitarian actors.Moving forward,the study advocates for improved collaboration between humanitarian and disaster management sectors to strengthen disaster prevention,response,and mitigation.By examining the relationship between SFDRR objectives and modern humanitarian practices,this research aims to enhance disaster preparedness,response,and recovery strategies,alongside other crisis management approaches.
基金funding provided by FCT|FCCN(b-on)This study is supported by Major science and technology projects and key R&D plans/programs,Yunnan Province(202202AE090001)+4 种基金The open research project of“Cross-Cooperative Team”of the Germplasm Bank of Wild Species,Kunming Institute of Botany,Chinese Academy of Sciences(Grant No.292019312511043)The Biodiversity Survey and Assessment Project of the Ministry of Ecology and Environment,PR China(2019HJ2096001006)The National Research Council of Thailand(NRCT)grant“Total fungal diversity in a given forest area with implications towards species numbers,chemical diversity and biotechnology”(Grant No.N42A650547)Didsanutda Gonkhom thanks the support from Research and researcher for industries(Grant No.PHD62I0018/2562).We thank Kunming Institute of Botany,Chinese Academy of Sciences,Flexible Talent Introduction Program-(E16441)The authors extend their appreciation to the International Scientific Partnership Program ISPP at King Saud University for funding this research work through ISPP-151.
文摘The field of mycology has grown from an underappreciated subset of botany,to a valuable,modern scientific discipline.As this field of study has grown,there have been significant contributions to science,technology,and industry,highlighting the value of fungi in the modern era.This paper looks at the current research,along with the existing limitations,and suggests future areas where scientists can focus their efforts,in the field mycology.We show how fungi have become important emerging diseases in medical mycology.We discuss current trends and the potential of fungi in drug and novel compound discovery.We explore the current trends in phylogenomics,its potential,and outcomes and address the question of how phylogenomics can be applied in fungal ecology.In addition,the trends in functional genomics studies of fungi are discussed with their importance in unravelling the intricate mechanisms underlying fungal behaviour,interactions,and adaptations,paving the way for a comprehensive understanding of fungal biology.We look at the current research in building materials,how they can be used as carbon sinks,and how fungi can be used in biocircular economies.The numbers of fungi have always been of great interest and have often been written about and estimates have varied greatly.Thus,we discuss current trends and future research needs in order to obtain more reliable estimates.We address the aspects of machine learning(AI)and how it can be used in mycological research.Plant pathogens are affecting food production systems on a global scale,and as such,we look at the current trends and future research needed in this area,particularly in disease detection.We look at the latest data from High Throughput Sequencing studies and question if we are still gaining new knowledge at the same rate as before.A review of current trends in nanotechnology is provided and its future potential is addressed.The importance of Arbuscular Mycorrhizal Fungi is addressed and future trends are acknowledged.Fungal databases are becoming more and more important,and we therefore provide a review of the current major databases.Edible and medicinal fungi have a huge potential as food and medicines,especially in Asia and their prospects are discussed.Lifestyle changes in fungi(e.g.,from endophytes,to pathogens,and/or saprobes)are also extremely important and a current research trend and are therefore addressed in this special issue of Fungal Diversity.
文摘Complementing our previous publications, this paper presents the information schema constructs （ISCs） that underpin the programming of specific system manifestation feature （SMF） orientated information management and composing system models. First, we briefly present （1） the general process of pre-embodiment design with SMFs, （2） the procedures of creating genotypes and phenotypes of SMFs, （3） the specific procedure of instantiation of phenotypes of SMFs, and （4） the procedure of system model management and processing. Then, the chunks of information needed for instantiation of phenotypes of SMFs are discussed, and the ISCs designed for instantiation presented. Afterwards, the information management aspects of system modeling are addressed. Methodologically, system modeling involves （1） placement of phenotypes of SMF in the modeling space, （2） combining them towards the desired architecture and operation, （3） assigning values to the parameters and checking the satisfac- tion of constraints, and （4） storing the system model in the SMFs-based warehouse database. The final objective of the reported research is to develop an SMFs-based toolbox to support modeling of cyber-physical systems （CPSs）.
文摘Several treatment options corresponding to the grade of keratoconus have been established.These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus,and penetrating keratoplasty or deep anterior lamellar keratoplasty for the more advanced cases of keratoconus.Bowman layer transplantation was developed as a procedure for patients with advanced,progressive keratoconus.The technique consists of transplanting an isolated donor Bowman layer into a mid-stromal pocket of a keratoconic cornea resulting in corneal flattening and stabilization against further ectasia.Thus,it aims at corneal stabilization in eyes with advanced keratoconus,and enabling continued contact lens wear for normal visual functionality.By being a sutureless procedure and using an acellular graft,it potentially avoids commonly known suture and graftrelated complications of penetrating or deep anterior lamellar keratoplasty.The treatment seems to be a promising option in the management of advanced keratoconus in order to postpone or prevent a more invasive corneal surgery,while minimizing the risk of complications and allowing less stringent surveillance and less intensive medical therapy.
文摘Background:To evaluate the efficacy of manual mid-stromal dissection in stabilizing progressive keratoconus.Methods:Surgeries were performed in 16 eyes of 14 patients with progressive keratoconus.All eyes were examined before and at 1 day,1 week,1,3,6 and 12 months after surgery,and every 6 months thereafter.Pentacam(simK,Kmax and pachymetry),best corrected visual acuity(BCVA)and subjective refraction were recorded up to the latest follow-up visit(mean follow-up time 6.6±2.4 years).Results:All surgeries were uneventful,and no postoperative complications occurred.Keratometry values(n=15)stabilized in 6/11 eyes(55%)with a preoperative Kmax<60.0 diopter(D),while all eyes>60 D showed continued progression.In 11/15 eyes(73%)pachymetry was unchanged.BCVA with spectacles remained stable in 7/12 eyes(58%)and improved≥2 Snellen lines in 5/12 eyes(42%).BCVA with a contact lens remained stable in 4/9 eyes(44%),improved≥2 Snellen lines in 3/9 eyes(33%)and deteriorated in 2/9 eyes(22%).Conclusions:Manual mid-stromal dissection was effective in 50%of keratoconic corneas with Kmax values<60 D and may be considered in cases ineligible for other interventions such as UV-crosslinking,stromal ring implantation or Bowman layer transplantation.An advantage of the procedure may be that the tissue is unaltered and that no synthetic or biological implant is required.
