Search Results (43)

Background/Objective: The poultry industry requires extensive vaccination of chickens against IBV in an effort to prevent the disease in animals and significant economic losses. Current vaccination strategies often lack effectiveness, and the continual emergence of new IBV variants makes disease control increasingly challenging. We have developed an inactivated vaccine for poultry containing nine different antigens (Nobilis Multriva), including two IBDV strains, two ARV strains, one NDV strain, one AMPV strain, one EDSV strain and two IBV strains: M41 (genotype GI-1) and 4–91 (genotype GI-13). In this study, the IB efficacy of this novel inactivated vaccine was investigated against homologous and heterologous IBV strains. Methods: Inactivated IBV vaccine containing the M41 and 4–91 strains (Nobilis Multriva) was administered intramuscularly, either alone or following vaccine priming, in SPF and commercial chickens. Birds were challenged with homologous and heterologous IBV strains at defined ages (peak of lay, mid-lay and end of lay). Vaccine efficacy was evaluated through serological assays, clinical observations, and monitoring of egg production post-challenge. Results: This vaccine provided excellent broad protection against different IBV strains circulating in different parts of the world, including IBV M41, 4–91, QX, Q1 and Var2. Furthermore, the vaccine provided long-lasting IBV serological response against IB M41 and IB 4–91 until at least 96 weeks of age in SPF and commercial layers and breeder birds. This vaccine will allow farmers to reduce the number of vaccination moments, thereby minimizing stress to the birds, while also decreasing labor demands and the risk of human error, ultimately contributing to lower overall vaccination costs. Conclusions: Given its demonstrated broad cross-protection and sustained serological responses, this nine-valent inactivated vaccine (Nobilis Multriva) represents a key component of an effective vaccination regimen for controlling IBV infections in the poultry industry. Full article

The growing strain on global healthcare systems, driven by aging populations, rising prevalence of chronic diseases, and workforce shortages, has increased interest in strategies that enhance perioperative outcomes and healthcare sustainability. From this perspective, prehabilitation—a proactive, multimodal approach to enhance patients’ functional, nutritional, and psychological status prior to surgery—has gained attention as a potential contributor to value-based, personalized care. This study aims to synthesize mechanistic rationale, clinical evidence, and system-level considerations for prehabilitation, with particular focus on allostatic capacity and the body’s response to surgical stress. Current evidence shows that prehabilitation may reduce postoperative complications, shorten hospital stays, and improve functional recovery, particularly when interventions are multimodal. However, the existing literature is characterized by methodological heterogeneity and variable quality, seemingly limiting generalizability and large-scale implementation. Further research is required to standardize outcome measures, identify patient subgroups most likely to benefit, and evaluate cost-effectiveness. Integration of prehabilitation into perioperative care pathways will depend on improved mechanistic understanding, robust clinical trials, and alignment with broader health policy and system-level initiatives. Prehabilitation may represent a meaningful step toward value-based and sustainable surgical care, though its implementation must be guided by high-quality evidence and careful consideration of context-specific factors. Full article

Background/Objectives: Maternal vitamin supplementation (including folic acid, vitamin D, and multivitamin supplements) during pregnancy may lower the likelihood of neurodevelopmental disorders in offspring. This study examines the associations between maternal vitamin suppletion during pregnancy and morphological patterns in offsprings’ brain structure and traits of Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) in a large population-based study of child development. Methods: The study cohort included a total of 3937 children (aged 9–11) participating in the Generation R cohort in Rotterdam, the Netherlands. Maternal vitamin D and folateserum levels, multivitamin supplement use, and overall dietary quality (as assessed by the Food Frequency Questionnaire, FFQ) during pregnancy were used as predictors. T1 structural MRI scans were acquired and segmented using Freesurfer to assess brain morphometry. Cortical and subcortical brain volumes of children were separated into four independent components and used as mediators. ADHD and ASD traits, as measured by parent-completed questionnaires (Child Behavior CheckList and Social Responsiveness Scale, respectively) were used as outcome variables. Results: Results show that (1) maternal vitamin D, multivitamin supplementation, and better diet quality were associated with fewer ADHD or ASD traits in the offspring; (2) vitamin D and diet quality were associated with larger-volume childhood brain components; (3) larger-volume brain components were associated with fewer ADHD and ASD traits; (4) part of the association between dietary factors in pregnancy and offspring ADHD and ASD traits was mediated through the brain volumes of the children. Conclusions: Though all observed effect sizes were small, further population-based research should be performed to further delineate the effects of gestational multivitamin and vitamin D exposure and investigate whether this may be an avenue for preventive interventions. Full article

This study presents the total cost of ownership (TCO) of battery electric buses across Europe (the EU27 + UK + Türkiye). A comprehensive review of the assumptions and data used for the TCO calculation of buses in the literature is provided, along with calculations of the different bus TCO excluding labor costs, across these countries. The calculated TCO is compared with diesel costs in each country to identify the countries in which bus electrification is financially most competitive. The study reveals that the financial case for bus electrification is strongest in Finland, France, Belgium and Greece (TCOs around €750k to €850k and high diesel costs in the range of €1.70 per liter) and is weakest in Malta, Bulgaria and Cyprus. These results are expected to be of interest for operators, academics, policy makers, and financial investors in bus electrification. Full article

Hospital layouts play a critical role in supporting efficient care processes, which are continually evolving. While care processes adapt over time, the spatial needs of care professionals are expected to remain relatively stable. This study proposes an evaluation framework combining cognitive mapping and space syntax analysis (SSA) to assess how hospital layouts align with these spatial needs. The framework is applied to a real-world emergency department (ED) with two distinct layout configurations. Cognitive mapping captures spatial needs from the perspective of care professionals, while SSA evaluates how the layout supports or constrains these needs. Drawing on the open building approach, we interpret layout adaptability through a layered system of primary (rigid), secondary (adaptable), and tertiary (care process) levels. Our results show that the choices in primary and secondary system designs can limit the functionality of the tertiary system. This approach supports informed decision-making by addressing multiple spatial needs simultaneously, offering insights into the coherence between spatial configuration and care delivery, and enabling quantitative comparison across different layout designs. Full article

Background: The gold standard for diagnosing primary central nervous system lymphoma (PCNSL) is brain biopsy, an invasive procedure with significant risks. The role of cerebrospinal fluid (CSF) examination, limited to cytology and flow cytometry in current practice, is acknowledged as a less invasive diagnostic method. We aimed to summarize available data concerning the efficacy and actual use of current standard CSF diagnostics in the diagnosis of PCNSL. Methods: A systematic review and meta-analysis of 144 studies (n = 9493 patients) was conducted, assessing detection rates of cytology and flow cytometry and the proportion of diagnoses based on CSF analysis. The QUADAS-2 tool was used to evaluate study quality and bias. Results: Meta-analysis showed an 18% pooled detection rate for positive CSF results, with 17% for cytology and 20% for flow cytometry. Only 8% of diagnoses were made using CSF analysis. Most studies had a high risk of bias. Conclusions: Despite its established role in guidelines, CSF analysis remains underutilized for diagnosing PCNSL, with room to improve its clinical impact. Novel techniques, such as chemokines and circulating tumor DNA (cfDNA) analysis, hold promise to unlock the untapped potential of CSF diagnostics, offering significant advancements in non-invasive PCNSL diagnosis. Full article

In same-day radioembolization, 99mTc-MAA SPECT/CT, 90Y radioembolization, and post-treatment 90Y SPECT/CT procedures are conducted on the same-day, resulting in a dual-isotope environment of 90Y and 99mTc during post-treatment imaging. This study aimed to quantify the impact of 99mTc on 90Y bremsstrahlung-SPECT/CT image quality and to establish an optimised imaging protocol for both clinical practice, and with advanced reconstruction techniques. Utilising a NEMA IQ phantom, contrast recovery coefficients (CRCs) were measured to evaluate the 90Y image quality degradation caused by 99mTc. SPECT/CT scans of 90Y-only and 90Y with varying amounts of 99mTc were conducted using a standard protocol (90–120 keV energy window, high-energy collimator) and various dual-isotope protocols. The standard protocol resulted in a marked CRC reduction, with the largest sphere’s CRC decreasing from 0.21 (90Y-only) to 0.05 when 99mTc activity was 5% of 90Y. For an optimised protocol (160–200 keV energy window, high-energy collimator) CRC values were 0.16 for 90Y-only and 0.15 for 90Y+99mTc. The highest CRC values were achieved with an advanced Monte Carlo-based reconstruction, showing 0.58 for 90Y-only and 0.46 for 90Y+99mTc. Image quality degradation was noted in dual-isotope settings even when using an optimised protocol. Advanced reconstruction techniques markedly improved post-treatment image quality. Full article

Within rehabilitation, there is a great need for a simple method to monitor wheelchair use, especially whether it is active or passive. For this purpose, an existing measurement technique was extended with a method for detecting self- or attendant-pushed wheelchair propulsion. The aim of this study was to validate this new detection method by comparison with manual annotation of wheelchair use. Twenty-four amputation and stroke patients completed a semi-structured course of active and passive wheelchair use. Based on a machine learning approach, a method was developed that detected the type of movement. The machine learning method was trained based on the data of a single-wheel sensor as well as a setup using an additional sensor on the frame. The method showed high accuracy (F1 = 0.886, frame and wheel sensor) even if only a single wheel sensor was used (F1 = 0.827). The developed and validated measurement method is ideally suited to easily determine wheelchair use and the corresponding activity level of patients in rehabilitation. Full article

Precision Livestock Farming systems can help pig farmers prevent health and welfare issues around farrowing. Five sows were monitored in two field studies. A Sorama L642V sound camera, visualising sound sources as coloured spots using a 64-microphone array, and a Bascom XD10-4 security camera with a built-in microphone were used in a farrowing unit. Firstly, sound spots were compared with audible sounds, using the Observer XT (Noldus Information Technology), analysing video data at normal speed. This gave many false positives, including visible sound spots without audible sounds. In total, 23 of 50 piglet births were visible, but none were audible. The sow’s behaviour changed when farrowing started. One piglet was silently crushed. Secondly, data were analysed at a 10-fold slower speed when comparing sound spots with audible sounds and sow behaviour. This improved results, but accuracy and specificity were still low. When combining audible sound with visible sow behaviour and comparing sound spots with combined sound and behaviour, the accuracy was 91.2%, the error was 8.8%, the sensitivity was 99.6%, and the specificity was 69.7%. We conclude that sound cameras are promising tools, detecting sound more accurately than the human ear. There is potential to use sound cameras to detect the onset of farrowing, but more research is needed to detect piglet births or crushing. Full article

Background: Lower extremity free flap dangling protocols are still widely practiced, despite a paucity of evidence for their use. This pilot study investigates the use of tissue oximetry to provide further insight into the physiological effect of postoperative dangling in lower limb free flap transfer. Methods: Ten patients undergoing lower extremity free flap reconstruction were included in this study. Free flap tissue oxygen saturation (StO₂) was continuously measured using non-invasive near-infrared spectroscopy. Measurements were performed on the free flap and contralateral limb during dangling from postoperative day (POD) 7 until 11, according to the local dangling protocol. Results: StO₂ values measured in the free flap diminished to 70 ± 13.7% during dangling. This minimum StO₂ was reached significantly later, and correspondingly the area under the curve (AUC) was significantly larger on POD 11 compared to the start of the dangling protocol on POD 7, reflecting an improving free flap microvascular reactivity. The dangling slope was equal between the free flap and contralateral leg. The reperfusion slope was significantly flatter on POD 7 compared to the other PODs (p < 0.001). Thereafter, no significant differences between PODs were observed. Patients with a history of smoking had significantly lower tissue oximetry values compared to non-smokers. Conclusions: The application of tissue oximetry during dangling provides further insight into the physiological effect (i.e., changes in microcirculatory function) of the free flap of the reconstructed lower extremity. This information could potentially be useful to either revise or disrupt the use of such dangling protocols. Full article

Chronic kidney disease (CKD) is represented by a diminished filtration capacity of the kidneys. End-stage renal disease patients need dialysis treatment to remove waste and toxins from the circulation. However, endogenously produced uremic toxins (UTs) cannot always be filtered during dialysis. UTs are among the CKD-related factors that have been linked to maladaptive and pathophysiological remodeling of the heart. Importantly, 50% of the deaths in dialysis patients are cardiovascular related, with sudden cardiac death predominating. However, the mechanisms responsible remain poorly understood. The current study aimed to assess the vulnerability of action potential repolarization caused by exposure to pre-identified UTs at clinically relevant concentrations. We exposed human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and HEK293 chronically (48 h) to the UTs indoxyl sulfate, kynurenine, or kynurenic acid. We used optical and manual electrophysiological techniques to assess action potential duration (APD) in the hiPSC-CMs and recorded I_Kr currents in stably transfected HEK293 cells (HEK-hERG). Molecular analysis of K_V11.1, the ion channel responsible for I_Kr, was performed to further understand the potential mechanism underlying the effects of the UTs. Chronic exposure to the UTs resulted in significant APD prolongation. Subsequent assessment of the repolarization current I_Kr, often most sensitive and responsible for APD alterations, showed decreased current densities after chronic exposure to the UTs. This outcome was supported by lowered protein levels of K_V11.1. Finally, treatment with an activator of the I_Kr current, LUF7244, could reverse the APD prolongation, indicating the potential modulation of electrophysiological effects caused by these UTs. This study highlights the pro-arrhythmogenic potential of UTs and reveals a mode of action by which they affect cardiac repolarization. Full article

Background: Hypoxic-ischemic encephalopathy (HIE) is a severe pathology, and no unique predictive biomarker has been identified. Our aims are to identify associations of perinatal and outcome parameters with morphological anomalies and ADC values from MRI. The secondary aims are to define a predictive ADC threshold value and detect ADC value fluctuations between MRIs acquired within 7 days (MR0) and at 1 year (MR1) of birth in relation to perinatal and outcome parameters. Methods: Fifty-one term children affected by moderate HIE treated with hypothermia and undergoing MRI0 and MRI1 were recruited. Brain MRIs were evaluated through the van Rooij score, while ADC maps were co-registered on a standardized cerebral surface, on which 29 ROIs were drawn. Statistical analysis was performed in Matlab, with the statistical significance value at 0.05. Results: ADC0 < ADC1 in the left and right thalami, left and right frontal white matter, right visual cortex, and the left dentate nucleus of children showing abnormal perinatal and neurodevelopmental parameters. At ROC analysis, the best prognostic ADC cut-off value was 1.535 mm²/s × 10⁻⁶ (sensitivity 80%, specificity 86%) in the right frontal white matter. ADC1 > ADC0 in the right visual cortex and left dentate nucleus, positively correlated with multiple abnormal perinatal and neurodevelopmental parameters. The van Rooij score was significantly higher in children presenting with sleep disorders. Conclusions: ADC values could be used as prognostic biomarkers to predict children’s neurodevelopmental outcomes. Further studies are needed to address these crucial topics and validate our results. Early and multidisciplinary perinatal evaluation and the subsequent re-assessment of children are pivotal to identify physical and neuropsychological disorders to guarantee early and tailored therapy. Full article

Improving the prediction of blood glucose concentration may improve the quality of life of people living with type 1 diabetes by enabling them to better manage their care. Given the anticipated benefits of such a prediction, numerous methods have been proposed. Rather than attempting to predict glucose concentration, a deep learning framework for prediction is proposed in which prediction is performed using a scale for hypo- and hyper-glycemia risk. Using the blood glucose risk score formula proposed by Kovatchev et al., models with different architectures were trained, including, a recurrent neural network (RNN), a gated recurrent unit (GRU), a long short-term memory (LSTM) network, and an encoder-like convolutional neural network (CNN). The models were trained using the OpenAPS Data Commons data set, comprising 139 individuals, each with tens of thousands of continuous glucose monitor (CGM) data points. The training set was composed of 7% of the data set, while the remaining was used for testing. Performance comparisons between the different architectures are presented and discussed. To evaluate these predictions, performance results are compared with the last measurement (LM) prediction, through a sample-and-hold approach continuing the last known measurement forward. The results obtained are competitive when compared to other deep learning methods. A root mean squared error (RMSE) of 16 mg/dL, 24 mg/dL, and 37 mg/dL were obtained for CNN prediction horizons of 15, 30, and 60 min, respectively. However, no significant improvements were found for the deep learning models compared to LM prediction. Performance was found to be highly dependent on architecture and the prediction horizon. Lastly, a metric to assess model performance by weighing each prediction point error with the corresponding blood glucose risk score is proposed. Two main conclusions are drawn. Firstly, going forward, there is a need to benchmark model performance using LM prediction to enable the comparison between results obtained from different data sets. Secondly, model-agnostic data-driven deep learning models may only be meaningful when combined with mechanistic physiological models; here, it is argued that neural ordinary differential equations may combine the best of both approaches. These findings are based on the OpenAPS Data Commons data set and are to be validated in other independent data sets. Full article

Cities are growing rapidly. It takes a chain of activities to get food from farms to cities. This food system is largely driven by autonomous market development, seizing opportunities favourable to a stakeholder but unfavourable to society at large. Spatial planning is crucial along the chain of food system activities to improve food system outcomes, resilience, and limit negative trade-offs. To include the food system in spatial planning, it must first be mapped (i.e., spatialisation) to understand the functions. These maps inform the spatial planning process, which in turn influences spatial configuration of activities. This paper explores the role of spatialisation and spatial planning in the food system of the fast-growing Dhaka Metropolitan Area (DMA) using three different approaches: urban footprint, mapping, and semi-structured interviews. Stakeholders are unaware of spatial aspects that are present in DMA’s food system and therefore do not consider it while developing spatial plans. The analysis in this article, based on the Urban Food Footprint analysis, food system spatialisation, and interviews shows that spatial planning informed by descriptive spatial information can play an important role in guiding the transformation to a more robust, resilient, and inclusive food system. Full article

Acanthamoeba keratitis is almost universally associated with contact lens (CL) use. Until today, however, CL solution manufacturing protocols lack testing of anti-amoebic activity. This study investigates the effectiveness of CL solutions available on the Dutch market against trophozoites and cysts of Acanthamoeba castellanii and Acanthamoeba polyphaga. Sixteen CL solutions were tested: 13 multiple purpose solutions (MPS), 2 hydrogen peroxidase solutions (HPS) and 1 povidone-iodine-based solution (PIS). The Spearman–Karber (SK) log reduction method and an XTT colorimetric assay were used to evaluate the effectiveness at the manufacturer’s minimum recommended disinfection time (MMRDT) and after eight hours. At the MMRDT, one MPS showed an SK mean log reduction (MLR) of >3.0 against A. castellanii trophozoites. Two additional MPS and both HPS reached this threshold after eight hours. The SK MLR values for A. polyphaga trophozoites were between 1 and 3 at all time points. Using the XTT colorimetric assay, only HPS 1 showed >99.9% reduction (equivalent to 3 log reduction) in metabolic activity of A. castellanii trophozoites after eight hours. For A. polyphaga, both HPS and PIS showed a metabolic reduction of >99.9% after eight hours. Cysts were resistant against all solutions. We conclude that following the manufacturer’s guidelines, few solutions provide sufficient effectiveness against Acanthamoeba trophozoites and none against cysts. The results underline the importance of adequate hygiene when handling CLs. Full article