Student burnout is raising an increasing amount of concern. Burnout often leads to psychosocial problems and drop-out. In this study multiple regression analysis was used to examine the impact of ...performance pressure, loneliness, and sense of belonging on the underlying dimensions of burnout in 3,134 university students in the Netherlands. Results suggest that sense of belonging could be targeted as a way to enhance student wellbeing, in order to improve the ability to cope with the high demands in student life and the prevention of burnout.
•Increasing verbal working memory load reduced lane change task performance: the affected measures included lane keeping as well as event detection.•Higher working memory capacity related to better ...lane change task performance.•Participants with higher verbal working memory capacity were less negatively influenced by increasing verbal WM load on event detection measures.•Nonetheless, completely eliminating distraction is necessary to minimize crash risks among young novice drivers.
Distracted driving has received increasing attention in the literature due to potential adverse safety outcomes. An often posed solution to alleviate distraction while driving is hands-free technology. Interference by distraction can occur however at the sensory input (e.g., visual) level, but also at the cognitive level where hands-free technology induces working memory (WM) load. Active maintenance of goal-directed behavior in the presence of distraction depends on WM capacity (i.e., Lavie's Load theory) which implies that people with higher WM capacity are less susceptible to distractor interference. This study investigated the interaction between verbal WM load and WM capacity on driving performance to determine whether individuals with higher WM capacity were less affected by verbal WM load, leading to a smaller deterioration of driving performance. Driving performance of 46 young novice drivers (17–25 years-old) was measured with the lane change task (LCT). Participants drove without and with verbal WM load of increasing complexity (auditory-verbal response N-back task). Both visuospatial and verbal WM capacity were investigated. Dependent measures were mean deviation in the lane change path (MDEV), lane change initiation (LCI) and percentage of correct lane changes (PCL). Driving experience was included as a covariate. Performance on each dependent measure deteriorated with increasing verbal WM load. Meanwhile, higher WM capacity related to better LCT performance. Finally, for LCI and PCL, participants with higher verbal WM capacity were influenced less by verbal WM load. These findings entail that completely eliminating distraction is necessary to minimize crash risks among young novice drivers.
Abstract
Background
The EANO ESMO guidelines have proposed a classification of leptomeningeal metastases (LM) from solid cancers based on clinical, magnetic resonance imaging (MRI), and cerebrospinal ...fluid (CSF) cytology presentation. MRI patterns are classified as linear, nodular, both, or neither. Type I LM is defined by positive CSF cytology (confirmed LM) whereas type II LM is defined by typical clinical and MRI signs (probable or possible LM). Here we explored the clinical utility of these LM subtypes.
Patients and methods
We retrospectively assembled data from 254 patients with newly diagnosed LM from solid tumors. Survival curves were derived using the Kaplan–Meier method and compared by Log-rank test.
Results
Median age at LM diagnosis was 56 years. Typical clinical LM features were noted in 225 patients (89%); 13 patients (5%) were clinically asymptomatic. Tumor cells in the CSF were observed in 186 patients (73%) whereas the CSF was equivocal in 24 patients (9.5%) and negative in 44 patients (17.5%). Patients with confirmed LM had inferior outcome compared with patients with probable or possible LM (P = 0.006). Type I patients had inferior outcome than type II patients (P = 0.002). Nodular disease on MRI was a negative prognostic factor in type II LM (P = 0.014), but not in type I LM. On multivariate analysis, administration of either intrathecal pharmacotherapy (P = 0.012) or systemic pharmacotherapy (P = 0.0003) was associated with improved outcome in type I LM, but not in type II LM.
Conclusion
The EANO ESMO LM subtypes are highly prognostic and should be considered for stratification and overall design of clinical trials.
Risk factors of loneliness across the life span Hutten, Elody; Jongen, Ellen M. M.; Hajema, KlaasJan ...
Journal of social and personal relationships,
05/2022, Letnik:
39, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Although loneliness is typically associated with adolescence and old age, research has revealed that it is prevalent across the life span. The present study contributes to the loneliness literature ...by investigating a broad range of risk factors in a Dutch sample (N = 52,341) ranging from late adolescence to old age using a cross-sectional survey administered by the regional public health services in the province of Limburg in the Netherlands. Risk factors associated with higher levels of self-reported loneliness across the life span were being male, lower education levels, inadequacy of financial resources, mental health, informal caregiving that is experienced as burdensome, and limited social contact or network type. In addition, in early adulthood, having a non-western migration background and having a physical disability were associated with higher levels of loneliness, whereas living alone, having a non-western migration background, and not having a paid job were risk factors of loneliness in middle adulthood. In late adulthood, living alone and having a physical disability were associated with loneliness. The present study demonstrates that different stages of life are associated with different vulnerability factors of loneliness. Hence, the prevention of loneliness might require different interventions in different age groups.
Objective
Near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) might help reduce anastomotic leakage (AL) after colorectal surgery. This pilot study aims to analyze whether a ...relation exists between measured fluorescence intensity (FI) and postoperative inflammatory markers of AL, C-reactive protein (CRP), Intestinal fatty-acid binding protein (I-FABP), and calprotectin, to AL, in order to evaluate the potential of FI to objectively predict AL.
Methods
Patients scheduled for anastomotic colorectal cancer surgery were eligible for inclusion in this prospective pilot study. During surgery, at three time points (after bowel devascularization; before actual transection; after completion of anastomosis) a bolus of 0.2 mg/kg ICG was administered intravenously for assessment of bowel perfusion. FI was scored in scale from 1 to 5 based on the operating surgeon’s judgment (1 = no fluorescence visible, 5 = maximum fluorescent signal). The complete surgical procedure was digitally recorded. These recordings were used to measure FI postoperatively using OsiriX imaging software. Serum CRP, I-FABP, and calprotectin values were determined before surgery and on day 1, 3, and 5 postoperative; furthermore, the occurrence of AL was recorded.
Results
Thirty patients (
n
= 19 males; mean age 67 years; mean BMI 27.2) undergoing either laparoscopic or robotic anastomotic colorectal surgery were included. Indication for surgery was rectal—(
n
= 10), rectosigmoid—(
n
= 2), sigmoid—(
n
= 10), or more proximal colon carcinomas (
n
= 8). Five patients (16.7%) developed AL (
n
= 2 (6.6%) grade C according to the definition of the International Study group of Rectal Cancer). In patients with AL, the maximum fluorescence score was given less often (
P
= 0.02) and a lower FI compared to background FI was measured at 1st assessment (
P
= 0.039). However, no relation between FI and postoperative inflammatory parameters could be found.
Conclusion
Both subjective and measured FI seem to be related to AL. In this study, no relation between FI and inflammatory serum markers could yet be found.
The present study examined the relationship between developmental patterns of loneliness and psychosocial functioning among adolescents (9-21 years;
= 110, 52% male). Four-wave longitudinal data were ...obtained from the Nijmegen Longitudinal Study (NLS) on Infant and Child Development. Loneliness was measured at 9, 13, 16, and 21 years of age and anxiety, depression and self-esteem at 9 and 21 years of age. Using k-means cluster analysis, three trajectories of loneliness were identified as "stable low" (56% of the subjects), "high decreasing" (22% of the subjects), and "low increasing" (22% of the subjects). Importantly, trajectories of loneliness across adolescence significantly predicted psychosocial functioning in young adulthood. Both the "high-decreasing" and "low-increasing" loneliness clusters were associated with higher risk of depression and lower self-esteem compared to the "stable low" loneliness cluster. The "low-increasing" loneliness cluster was associated with higher risk of anxiety compared to the "stable low" loneliness cluster. These results indicate that loneliness in adolescence is a vulnerability that manifests itself in higher levels of anxiety and depression and lower self-esteem in young adulthood.
Summary Background The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting ...compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI between the two groups. Methods Patients with recently symptomatic carotid artery stenosis enrolled in ICSS were randomly assigned in a 1:1 ratio to receive carotid artery stenting or endarterectomy. Of 50 centres in ICSS, seven took part in the MRI substudy. The protocol specified that MRI was done 1–7 days before treatment, 1–3 days after treatment (post-treatment scan), and 27–33 days after treatment. Scans were analysed by two or three investigators who were masked to treatment. The primary endpoint was the presence of at least one new ischaemic brain lesion on diffusion-weighted imaging (DWI) on the post-treatment scan. Analysis was per protocol. This is a substudy of a registered trial, ISRCTN 25337470. Findings 231 patients (124 in the stenting group and 107 in the endarterectomy group) had MRI before and after treatment. 62 (50%) of 124 patients in the stenting group and 18 (17%) of 107 patients in the endarterectomy group had at least one new DWI lesion detected on post-treatment scans done a median of 1 day after treatment (adjusted odds ratio OR 5·21, 95% CI 2·78–9·79; p<0·0001). At 1 month, there were changes on fluid-attenuated inversion recovery sequences in 28 (33%) of 86 patients in the stenting group and six (8%) of 75 in the endarterectomy group (adjusted OR 5·93, 95% CI 2·25–15·62; p=0·0003). In patients treated at a centre with a policy of using cerebral protection devices, 37 (73%) of 51 in the stenting group and eight (17%) of 46 in the endarterectomy group had at least one new DWI lesion on post-treatment scans (adjusted OR 12·20, 95% CI 4·53–32·84), whereas in those treated at a centre with a policy of unprotected stenting, 25 (34%) of 73 patients in the stenting group and ten (16%) of 61 in the endarterectomy group had new lesions on DWI (adjusted OR 2·70, 1·16–6·24; interaction p=0·019). Interpretation About three times more patients in the stenting group than in the endarterectomy group had new ischaemic lesions on DWI on post-treatment scans. The difference in clinical stroke risk in ICSS is therefore unlikely to have been caused by ascertainment bias. Protection devices did not seem to be effective in preventing cerebral ischaemia during stenting. DWI might serve as a surrogate outcome measure in future trials of carotid interventions. Funding UK Medical Research Council, the Stroke Association, Sanofi-Synthélabo, European Union, Netherlands Heart Foundation, and Mach-Gaensslen Foundation.
Anastomotic leakage (AL) remains the most dreaded complication after colorectal surgery and causes high morbidity and mortality. The pathophysiology of AL remains unclear, despite numerous studies ...that have been conducted on animals and humans, probably due to the undetermined healing process of colorectal anastomoses. Increasing basic knowledge on this healing process may shed more light on causal factors of AL, and additionally reduce the quantity and accelerate the quality of experimental studies. In this debate article, our aim was to provide different perspectives on what is known about the colorectal healing process in relation to wound healing and AL.
Since knowledge on anastomotic healing is lacking, it remains difficult to conclude which factors are essential in preventing AL. This is essential information in the framework of humane animal research, where the focus should lie on Replacement, Reduction and Refinement (3Rs). While many researchers compare anastomotic healing with wound healing in the skin, there are substantial recognized differences, e.g. other collagen subtypes and different components involved. Based on our findings in literature as well as discussions with experts, we advocate stop considering anastomotic healing in the gastrointestinal tract and cutaneous healing as a similar process. Furthermore, intervention studies should at least address the anastomotic healing process in terms of histology and certain surrogate markers. Finally, the anastomotic healing process ought to be further elucidated - with modern techniques to achieve 3Rs in animal research--to provide starting points for potential interventions that can prevent AL.
Summary Background Bortezomib-induced peripheral neuropathy is a dose-limiting toxicity in patients with multiple myeloma, often requiring adjustment of treatment and affecting quality of life. We ...investigated the molecular profiles of early-onset (within one treatment cycle) versus late-onset (after two or three treatment cycles) bortezomib-induced peripheral neuropathy and compared them with those of vincristine-induced peripheral neuropathy during the induction phase of a prospective phase 3 trial. Methods In the induction phase of the HOVON-65/GMMG-HD4 trial, patients (aged 18–65 years) with newly diagnosed Salmon and Durie stage 2 or 3 multiple myeloma were randomly assigned to three cycles of bortezomib-based or vincristine-based induction treatment. We analysed the gene expression profiles and single-nucleotide polymorphisms (SNPs) of pretreatment samples of myeloma plasma cells and peripheral blood, respectively. This study is registered, number ISRCTN64455289. Findings We analysed gene expression profiles of myeloma plasma cells from 329 (39%) of 833 patients at diagnosis, and SNPs in DNA samples from 369 (44%) patients. Early-onset bortezomib-induced peripheral neuropathy was noted in 20 (8%) patients, and 63 (25%) developed the late-onset type. Early-onset and late-onset vincristine-induced peripheral neuropathy was noted in 11 (4%) and 17 (7%) patients, respectively. Significant genes in myeloma plasma cells from patients that were associated with early-onset bortezomib-induced peripheral neuropathy were the enzyme coding genes RHOBTB2 (upregulated by 1·59 times; p=4·5×10−5 ), involved in drug-induced apoptosis, CPT1C (1·44 times; p=2·9×10−7 ), involved in mitochondrial dysfunction, and SOX8 (1·68 times; p=4·28×10−13 ), involved in development of peripheral nervous system. Significant SNPs in the same patients included those located in the apoptosis gene caspase 9 (odds ratio OR 3·59, 95% CI 1·59–8·14; p=2·9×10−3 ), ALOX12 (3·50, 1·47–8·32; p=3·8×10−3 ), and IGF1R (0·22, 0·07–0·77; p=8·3×10−3 ). In late-onset bortezomib-induced peripheral neuropathy, the significant genes were SOD2 (upregulated by 1·18 times; p=9·6×10−3 ) and MYO5A (1·93 times; p=3·2×10−2 ), involved in development and function of the nervous system. Significant SNPs were noted in inflammatory genes MBL2 (OR 0·49, 95% CI 0·26–0·94; p=3·0×10−2 ) and PPARD (0·35, 0·15–0·83; p=9·1×10−3 ), and DNA repair genes ERCC4 (2·74, 1·56–4·84; p=1·0×10−3 ) and ERCC3 (1·26, 0·75–2·12; p=3·3×10−3 ). By contrast, early-onset vincristine-induced peripheral neuropathy was characterised by upregulation of genes involved in cell cycle and proliferation, including AURKA (3·31 times; p=1·04×10−2 ) and MKI67 (3·66 times; p=1·82×10−3 ), and the presence of SNPs in genes involved in these processes—eg, GLI1 (rs2228224 0·13, 0·02–0·97, p=1·18×10−2 and rs2242578 0·14, 0·02–1·12, p=3·00×10−2 ). Late-onset vincristine-induced peripheral neuropathy was associated with the presence of SNPs in genes involved in absorption, distribution, metabolism, and excretion—eg, rs1413239 in DPYD (3·29, 1·47–7·37, 5·40×10−3 ) and rs3887412 in ABCC1 (3·36, 1·47–7·67, p=5·70×10−3 ). Interpretation Our results strongly suggest an interaction between myeloma-related factors and the patient's genetic background in the development of treatment-induced peripheral neuropathy, with different molecular pathways being implicated in bortezomib-induced and vincristine-induced peripheral neuropathy. Funding German Federal Ministry of Education and Research, Dutch Cancer Foundation Queen Wilhelmina, European Hematology Association, International Myeloma Foundation, Erasmus MC, and Janssen-Cilag Orthobiotech.
•Initial support for a dual-process-theory of risky driving was found.•Red light running was more prevalent in the drive with peer passengers.•Speeding was more prevalent with peer passengers in ...drivers with low inhibitory control.•Distractive effects were reflected in lateral vehicle control.•Protective effects were found for amber lights and hazards.
Prior studies indicated higher collision rates among young novice drivers with peer passengers. This driving simulator study provided a test for a dual process theory of risky driving by examining social rewards (peer passengers) and cognitive control (inhibitory control). The analyses included age (17–18 yrs, n=30; 21–24 yrs, n=20). Risky, distracting, and protective effects were classified by underlying driver error mechanisms. In the first drive, participants drove alone. In the second, participants drove with a peer passenger. Red-light running (violation) was more prevalent in the presence of peer passengers, which provided initial support for a dual process theory of risk driving. In a subgroup with low inhibitory control, speeding (violation) was more prevalent in the presence of peer passengers. Reduced lane-keeping variability reflected distracting effects. Nevertheless, possible protective effects for amber-light running and hazard handling (cognition and decision-making) were found in the drive with peer passengers. Avenues for further research and possible implications for targets of future driver training programs are discussed.
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