Bohn Stafleu van Loghum (Netherlands)

Plant communities are often dispersal‐limited and zoochory can be an efficient mechanism for plants to colonize new patches of potentially suitable habitat. We predicted that seed dispersal by ungulates acts as an ecological filter – which differentially affects individuals according to their characteristics and shapes species assemblages – and that the filter varies according to the dispersal mechanism (endozoochory, fur‐epizoochory and hoof‐epizoochory). We conducted two‐step individual participant data meta‐analyses of 52 studies on plant dispersal by ungulates in fragmented landscapes, comparing eight plant traits and two habitat indicators between dispersed and non‐dispersed plants. We found that ungulates dispersed at least 44% of the available plant species. Moreover, some plant traits and habitat indicators increased the likelihood for plant of being dispersed. Persistent or nitrophilous plant species from open habitats or bearing dry or elongated diaspores were more likely to be dispersed by ungulates, whatever the dispersal mechanism. In addition, endozoochory was more likely for diaspores bearing elongated appendages whereas epizoochory was more likely for diaspores released relatively high in vegetation. Hoof‐epizoochory was more likely for light diaspores without hooked appendages. Fur‐epizoochory was more likely for diaspores with appendages, particularly elongated or hooked ones. We thus observed a gradient of filtering effect among the three dispersal mechanisms. Endozoochory had an effect of rather weak intensity (impacting six plant characteristics with variations between ungulate‐dispersed and non‐dispersed plant species mostly below 25%), whereas hoof‐epizoochory had a stronger effect (eight characteristics included five ones with above 75% variation), and fur‐epizoochory an even stronger one (nine characteristics included six ones with above 75% variation). Our results demonstrate that seed dispersal by ungulates is an ecological filter whose intensity varies according to the dispersal mechanism considered. Ungulates can thus play a key role in plant community dynamics and have implications for plant spatial distribution patterns at multiple scales. Synthesis Plant communities are often dispersal‐limited and zoochory can be an efficient mechanism for plants to colonize new patches of potentially suitable habitat. Our analysis is the first synthesis of ungulate seed dispersal that compares characteristics from both non‐dispersed and dispersed diaspores, distinguishing the three zoochory mechanisms ungulates are involved in: endozoochory, hoof‐epizoochory and fur‐epizoochory. We confirmed that seed dispersal by ungulates is an ecological filter whose intensity increases from endozoochory, then hoof‐epizoochory to finally fur‐epizoochory. By filtering seed traits through dispersal, ungulates can thus play a key role in plant community dynamics and have implications for plant spatial distribution patterns at multiple scales.

In 1984, Niklas Luhmann published Soziale Systeme in which he applies the idea of autopoiesis (= self-production) to social systems. Abstracted from its biological connotations, the concept of autopoiesis leads to a sharp distinction between different kinds of autopoietic organization, i.e. between life, consciousness and communication. According to Luhmann, the relationship between social systems and human beings cannot be adequately analysed except by taking into account that they are environments for one another. If this theoretical background is accepted, the concepts and theory of socialization need to be revised. Luhmann takes issues with classical notions such as internalization, inculcation, or 'socialization to the grounds of consensus' (Talcott Parsons). After a historical overview of social systems research and general systems theory, it is indicated how communications trigger further communications and realize the autopoiesis of social systems. In the second part of the article, the distinction between social systems and psychic systems is used to discuss issues crucial to socialization theory. Both a revision of the concept of socialization, and lines for an empirical research programme are proposed in accordance with Luhmann's theory of social systems.

Predicting brain pharmacokinetics is critical for central nervous system (CNS) drug development yet difficult due to ethical restrictions of human brain sampling. CNS pharmacokinetic (PK) profiles are often altered in CNS diseases due to disease-specific pathophysiology. We previously published a comprehensive CNS physiologically-based PK (PBPK) model that predicted the PK profiles of small drugs at brain and cerebrospinal fluid compartments. Here, we improved this model with brain non-specific binding and pH effect on drug ionization and passive transport. We refer to this improved model as Leiden CNS PBPK predictor V3.0 (LeiCNS-PK3.0). LeiCNS-PK3.0 predicted the unbound drug concentrations of brain ECF and CSF compartments in rats and humans with less than two-fold error. We then applied LeiCNS-PK3.0 to study the effect of altered cerebrospinal fluid (CSF) dynamics, CSF volume and flow, on brain extracellular fluid (ECF) pharmacokinetics. The effect of altered CSF dynamics was simulated using LeiCNS-PK3.0 for six drugs and the resulting drug exposure at brain ECF and lumbar CSF were compared. Simulation results showed that altered CSF dynamics changed the CSF PK profiles, but not the brain ECF profiles, irrespective of the drug's physicochemical properties. Our analysis supports the notion that lumbar CSF drug concentration is not an accurate surrogate of brain ECF, particularly in CNS diseases. Systems approaches account for multiple levels of CNS complexity and are better suited to predict brain PK.

Bachelor of Nursing 2020 is het nieuwe opleidingsprofiel voor de hbo-verpleegkundige, dat berekend is op de komende transities in de zorg. Uitgangspunt is de recente visie op gezondheid, waarin niet d

OBJECTIVE: To evaluate lung function and respiratory morbidity prospectively during the first year of life in patients with congenital diaphragmatic hernia and to study the effect of extracorporeal membrane oxygenation therapy. DESIGN: Prospective longitudinal cohort study. SETTING: Outpatient clinic of a tertiary-level pediatric hospital. PATIENTS: The cohort of 43 infants included 12 patients treated with extracorporeal membrane oxygenation. Evaluation was at 6 and 12 months; 33 infants were evaluated at both time points. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Maximal expiratory flow at functional residual capacity and functional residual capacity were measured with Masterscreen Babybody. Z-scores were calculated for maximal expiratory flow at functional residual capacity. Mean maximal expiratory flow at functional residual capacity values at 6 and 12 months were significantly below the expected values (mean z-score -1.4 and -1.5, respectively) without a significant change between both time points. Values did not significantly differ between extracorporeal membrane oxygenation and nonextracorporeal membrane oxygenation-treated patients. Functional residual capacity values were generally high, 47% were above the suggested normal range, and did not change significantly over time. Mean functional residual capacity values in extracorporeal membrane oxygenation-treated patients were significantly higher than in nonextracorporeal membrane oxygenation-treated patients (p = .006). The difference (5.1 mL/kg ± 1.8 SE) did not change significantly between the two time points. Higher mean airway pressure and longer duration of ventilation were associated with higher functional residual capacity. None of the perinatal characteristics was associated with maximal expiratory flow at functional residual capacity. Mean weight z-scores were significantly below zero at both time points (p < .001). Mean weight z-score in extracorporeal membrane oxygenation-treated patients were lower than in nonextracorporeal membrane oxygenation-treated patients (p = .046). CONCLUSIONS: Infants with congenital diaphragmatic hernia have decreased expiratory flows and increased functional residual capacity within the first year of life. Extracorporeal membrane oxygenation-treated patients with congenital diaphragmatic hernia may have more respiratory morbidity and concomitant growth impairment. Close follow-up beyond the neonatal period is therefore required.

The presence of serum antibodies is a biomarker of past infection. Instead of seroclassification aimed at measuring seroprevalence a population sample of serum antibody levels may be used to estimate the incidence of seroconversion. This article expands an earlier study into seroincidence estimation, employing models of the seroresponse that include probability of escaping infection, as well as nonexponential decay kinetics and different sources of noise. As previously, a constant force of infection is assumed. When the seroconversion rate is low, a substantial fraction of the population may not be old enough to have experienced any seroconversions, causing underestimation of seroconversion rates that may be substantial at young ages. A correction is given that can be shown to remove such age dependent bias. Simulation studies show that the updated models provide accurate estimates of seroconversion rates, but also that the presence of noise, when unaccounted for, may introduce considerable bias, especially at low (< 0.1/yr) seroconversion rates and young ages. The revised serocalculator scripts can be used to update the R package "seroincidence."

Pharmacometric models using lognormal distributions have become commonplace in pharmacokinetic-pharmacodynamic investigations. The extent to which it can be interpreted by traditional description of variability through the normal distribution remains elusive. In this tutorial, the comparison is made using formal approximation methods. The quality of the resulting approximation was assessed by the similarity of prediction intervals (PIs) to true values, illustrated using 80% PIs. Approximated PIs were close to true values when lognormal standard deviation (omega) was smaller than about 0.25, depending mostly on the desired precision. With increasing omega values, the precision of approximation worsens and starts to deteriorate at omega values of about 1. With such high omega values, there is no resemblance between the lognormal and normal distribution anymore. To support dissemination and interpretation of these nonlinear properties, some additional statistics are discussed in the context of the three regions of behavior of the lognormal distribution.

OBJECTIVE: Patients with functional somatic syndromes show reduced correspondence between induced physiological changes and self-reported symptoms in a rebreathing paradigm, as well as elevated symptoms unrelated to physiological changes after induction of negative affective states in an affective picture-viewing paradigm. Detailed results of both paradigms separately were published elsewhere. The main goal of the current report is to describe the relationship between the responses to these two paradigms measuring distortions in symptom perception in a well-described sample of patients with fibromyalgia and/or chronic fatigue syndrome. METHODS: Patients (N = 81) with fibromyalgia and/or chronic fatigue syndrome participated in a test session comprising four well-validated paradigms, including the picture-viewing and rebreathing paradigm. Using mixed model analyses, we tested whether the amount of affective modulation of symptom reporting was related to distorted perception of induced dyspnea. In an exploratory way, we assessed the role of several individual difference variables as moderators. RESULTS: There was no relationship between patients' amount of affective modulation of symptom reporting, as assessed with the picture paradigm, and level of distortion in dyspnea perception, as assessed with the rebreathing paradigm (effect of affective modulation in the subjective recovery from induced dyspnea: F1,70 = 0.16, p = .70; time by affective modulation interaction effect: F4,70 = 0.14, p = .97). CONCLUSIONS: Biased symptom reporting in one paradigm is unrelated to biased symptom reporting in the other paradigm, indicating that distortions in symptom perception in patients with functional somatic syndromes are not a trait-like, cross-situationally stable condition, but a versatile dysfunction that is context dependent.

The sole diagram in On the Origin of Species is generally considered to be merely an illustration of Darwin's ideas, but such an interpretation ignores the fact that Darwin himself expressly stated that the diagram helped him to discover and express his ideas. This article demonstrates that developing the so-called "tree diagram" substantially aided Darwin's heuristics. This demonstration is based on an interpretation of the diagram and of 17 sketches found in Darwin's scientific papers. The key to this interpretation is the meaning that Darwin assigned to the graphic elements (points, lines, and spaces) he used to construct the preliminary sketches and the diagram. I argue that each of the sketches contributed to the shaping of Darwin's ideas and that, in their succession, each added new elements that ultimately resulted in the fully developed published diagram.

Vaccine hesitancy (VH) is an issue for healthcare students, influenced by safety concerns and misinformation. The need for better communication training and understanding sociocultural factors in VH was highlighted in a European University Alliance seminar. Practical exercises like simulation role-playing, interprofessional collaboration, and digital literacy may improve vaccine education.

The consumption of asparagus is associated with the production of malodorous urine with considerable interindividual variability (IIV). To characterize the urinary odor kinetics after consumption of asparagus spears, we conducted a study with consenting attendees from two American Society for Clinical Pharmacology and Therapeutics (ASCPT) meetings. Subjects were randomized to eat a specific number of asparagus spears, and then asked to report their urinary odor perception. Eighty-seven subjects were included in the final analysis. A mixed effect proportional odds model was developed that adequately characterized the dose-response relationship. We estimated the half-life of the asparagus effect on malodorous urine to be 4.7 hours (relative standard error (RSE) = 13.2%), and identified a dose-response slope term with good precision (24.3%). Age was found as the predictor of IIV in slope estimates. This study design and tools can be used as a demonstration "crowdsourcing" project for studying population kinetics in organizational and educational settings.

This essay raises the question why there is a difference between the way we treat animals and humans, when it comes to killing. The question is analysed with the help of two special cases. On the one hand, a non-autonomous patient whose suffering is immense and hopeless. On the other hand, an old dog that equally suffers badly. The differences and similarities are analysed and discussed from the perspective of ethical theory. The discussion includes an analysis of the taboo on killing humans and the possible biological explanation for this phenomenon. It is argued that overriding this taboo causes existential moral doubts. This burden can serve as a moral justification for operating (even) more cautiously in case of the human patient. The conclusion has an impact on both our dealings with animals and humans.

Dit werkboek biedt handvatten om met pedagogisch medewerkers in gesprek te gaan over hun werk. Het laat zien hoe je samen na kunt denken over de pedagogische taken van het kindcentrum. Het boek is geschreven voor pedagogen, begeleiders, coaches en leidinggevenden in de kinderopvang.

'Wet toelating zorginstellingen' published in 'Algemene Wet Bijzondere Ziektekosten'

Introduction: One in three patients with type 2 diabetes (T2D) suffers from any stage of chronic kidney disease (CKD), a chronic illness associated with a high global burden that impacts not only the healthcare system but also societal costs. Addition of finerenone to the standard of care (SoC) for patients with advanced CKD and T2D has been shown to be cost-effective by reducing healthcare and societal costs. This analysis explores the cost-effectiveness of finerenone in patients with CKD (stages 1-4 with albuminuria) associated with T2D from a societal perspective, as broader societal costs are a crucial consideration in managing chronic illnesses. Research design and methods: The validated FINE-CKD model was populated with data from the pooled FIDELITY analysis (ie, a patient population with early-to-late stage CKD associated with T2D) to investigate the cost-effectiveness of the addition of finerenone to SoC compared with SoC alone, from a Dutch societal perspective. Sensitivity analyses were conducted to evaluate the impact of parameter uncertainty on the robustness of the model. Results: Our analysis shows that by adding finerenone to SoC, patients with mild to severe stage CKD and T2D gain 0.14 quality-adjusted life years (QALYs) compared with SoC alone, mainly due to a reduction in renal and cardiovascular events. The societal costs of these events are considerable (ie, €8481 and €9799 per patient over a lifetime in the finerenone and SoC arm, respectively), showing the relevance of a societal perspective in chronic diseases. Overall, finerenone leads to savings of €2713 per patient over a lifetime. Therefore, the addition of finerenone to SoC emerges as the dominant treatment option when compared with SoC alone. The sensitivity analysis shows that finerenone has a 62.3% chance to be dominant and an 83.8% chance to be cost-effective, considering a willingness-to-pay threshold of €20 000/QALY. Conclusions: This study highlights the burden that chronic diseases impose on healthcare systems and society, emphasising the relevance of incorporating a societal perspective in cost-effectiveness analyses. The analysis estimates that adding finerenone to SoC treatment for patients with mild to advanced CKD associated with is cost-effective from a healthcare and societal perspective.

Van alle AHA bestaat 5-10% uit een PDB PDB . Op volwassen leeftijd is het tegenwoordig een zeldzame afwijking, omdat deze bij de meeste patiënten op kinderleeftijd herkend wordt en de PDB meestal wordt gesloten. Er zijn echter patiënten bij wie de diagnose pas op volwassen leeftijd toevallig of door het ontstaan van klachten wordt gesteld.

Samenvatting Vooralsnog vergt het stellen van de diagnose blaascarcinoom (BC) een invasieve urethrocystoscopie (UCS). Bovendien zijn de recidiefpercentages hoog, hetgeen leidt tot een hoge frequentie van controle-UCS. Er is behoefte aan een snelle, niet-invasieve test met goede sensitiviteit (SN), specificiteit (SP) en een goede negatief voorspellende waarde (NVW) voor de detectie van primair of recidiverend BC. De Xpert Bladder Assay detecteert in circa 90 minuten vijf verschillende mRNA’s in urine (CRH, IGF2, UPK1B, ANXA10 en ABL1) die verhoogd aanwezig zijn bij BC. Het doel van deze studie is hiervan de testeigenschappen te bepalen.

Samenvatting Ook in de Nederlandse urologie dringt het begrip big data langzaam door. In dit abstractnummer een paar mooie voorbeelden. Geven meer data ook altijd meer inzicht? Dat blijft de vraag. In veel gevallen levert deze retrospectieve manier van onderzoek een leuk overzicht van de praktijk, maar niet altijd een verklaring voor de bevindingen.

Deze Proeven van bekwaamheid bevat een compleet pakket proeven voor de opleiding Helpende Zorg en Welzijn: vijf proeven voor Zorg en vijf voor Welzijn. De proeven sluiten perfect aan op het kwalificat

Transpositie van de grote arteriën (TGA TGA ) komt voor bij 5-8% van AHA (1 op 5000 geboorten), en twee tot drie keer zo vaak bij jongens als bij meisjes. TGA wordt het best gedefinieerd als concordante AV- en discordante VA-connectie discordante VA-connectie concordante AV-connectie : het morfologische RA is via de RV verbonden met de aorta, het morfologische LA is via de LV verbonden met de art. pulmonalis. Hierbij ligt de aorta meestal rechts vóór de art. pulmonalis (D-transpositie D-transpositie ). In 70% van de gevallen heeft men te maken met een geïsoleerde vorm, in 30% met een complexe vorm, dat wil zeggen geassocieerd met een belangrijk VSD, een obstructie van de LVOT of een combinatie van beide.