Erratum: Factors limiting vocal-tract length discrimination in cochlear implant simulations [J. Acoust. Soc. Am. 137(3), 1298-1308 (2015)].

Erratum: Factors limiting vocal-tract length discrimination in cochlear implant simulations [J. Acoust. Soc. Am. 137(3), 1298-1308 (2015)].

J Acoust Soc Am. 2016 Apr;139(4):1734

Authors: Gaudrain E, Başkent D

PMID: 27106320 [PubMed – in process]

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Relation between CYP2D6 Genotype, Phenotype and Therapeutic Drug Concentrations among Nortriptyline and Venlafaxine Users in Old Age Psychiatry.

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Relation between CYP2D6 Genotype, Phenotype and Therapeutic Drug Concentrations among Nortriptyline and Venlafaxine Users in Old Age Psychiatry.

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Relation between CYP2D6 Genotype, Phenotype and Therapeutic Drug Concentrations among Nortriptyline and Venlafaxine Users in Old Age Psychiatry.

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Relation between CYP2D6 Genotype, Phenotype and Therapeutic Drug Concentrations among Nortriptyline and Venlafaxine Users in Old Age Psychiatry.

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Ischaemia in heart failure with preserved ejection fraction; is it important?

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Ischaemia in heart failure with preserved ejection fraction; is it important?

Eur J Heart Fail. 2016 Apr 20;

Authors: van Veldhuisen DJ, de Boer RA

PMID: 27095562 [PubMed – as supplied by publisher]

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The Intelligibility of Interrupted Speech: Cochlear Implant Users and Normal Hearing Listeners.

The Intelligibility of Interrupted Speech: Cochlear Implant Users and Normal Hearing Listeners.

J Assoc Res Otolaryngol. 2016 Apr 18;

Authors: Bhargava P, Gaudrain E, Başkent D

Abstract
Compared with normal-hearing listeners, cochlear implant (CI) users display a loss of intelligibility of speech interrupted by silence or noise, possibly due to reduced ability to integrate and restore speech glimpses across silence or noise intervals. The present study was conducted to establish the extent of the deficit typical CI users have in understanding interrupted high-context sentences as a function of a range of interruption rates (1.5 to 24 Hz) and duty cycles (50 and 75 %). Further, factors such as reduced signal quality of CI signal transmission and advanced age, as well as potentially lower speech intelligibility of CI users even in the lack of interruption manipulation, were explored by presenting young, as well as age-matched, normal-hearing (NH) listeners with full-spectrum and vocoded speech (eight-channel and speech intelligibility baseline performance matched). While the actual CI users had more difficulties in understanding interrupted speech and taking advantage of faster interruption rates and increased duty cycle than the eight-channel noise-band vocoded listeners, their performance was similar to the matched noise-band vocoded listeners. These results suggest that while loss of spectro-temporal resolution indeed plays an important role in reduced intelligibility of interrupted speech, these factors alone cannot entirely explain the deficit. Other factors associated with real CIs, such as aging or failure in transmission of essential speech cues, seem to additionally contribute to poor intelligibility of interrupted speech.

PMID: 27090115 [PubMed – as supplied by publisher]

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Surgical management and autologous intestinal reconstruction in short bowel syndrome.

Surgical management and autologous intestinal reconstruction in short bowel syndrome.

Best Pract Res Clin Gastroenterol. 2016 Apr;30(2):263-80

Authors: Hommel MJ, van Baren R, Haveman JW

Abstract
Short bowel syndrome (SBS) is a serious condition with considerable morbidity and mortality. When treatment with parenteral nutrition fails and life-threatening complications occur, autologous intestinal reconstruction (AIR) should be considered before intestinal transplantation (ITx). Single or combined ITx should be reserved for patients with severe liver disease and as last resort in the treatment of SBS. Longitudinal intestinal lengthening and tailoring (LILT) has proven its value in AIR, but its availability depends on the expertise of the surgeons. Serial transverse enteroplasty (STEP) has similar success rates as LILT and fewer patients progress to ITx. STEP is also applicable at small bowel dilatation in ultra-short bowel syndrome. The scope may be widened when duodenal dilatation can be treated as well. Spiral intestinal lengthening and tailoring (SILT) is a promising alternative. More research is needed to confirm these findings. Therefore we suggest an international data registry for all intestinal lengthening procedures.

PMID: 27086890 [PubMed – in process]

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Neuroscience: Listening in on yourself.

Neuroscience: Listening in on yourself.

Nature. 2016 Apr 6;532(7597):32-33

Authors: Draaisma D

PMID: 27078554 [PubMed – as supplied by publisher]

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Predicting Performance in Higher Education Using Proximal Predictors.

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Predicting Performance in Higher Education Using Proximal Predictors.

PLoS One. 2016;11(4):e0153663

Authors: Niessen AS, Meijer RR, Tendeiro JN

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Conflicting Role of Water in the Activation of H2O2 and the Formation and Reactivity of Non-Heme Fe(III)-OOH and Fe(III)-O-Fe(III) Complexes at Room Temperature.

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Conflicting Role of Water in the Activation of H2O2 and the Formation and Reactivity of Non-Heme Fe(III)-OOH and Fe(III)-O-Fe(III) Complexes at Room Temperature.

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Betere eetlust door nachtelijke hemodialyse

Karin Ipema: Nutritional status in nocturnal hemodialysis Nierpatiënten die overgaan van conventionele hemodialyse overdag naar frequente nachtelijk …

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Effect veelgebruikte bloedverdunner kan al na vier weken voorspeld worden

Hilde Kooistra: Determinants of effective, safe and convenient vitamin K antagonist use Zo’n 475.000 trombosepatiënten in Nederland gebruiken …

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Duurzame inzetbaarheid van werknemers niet aantoonbaar verbeterd door gezondheidsprogramma

Berry van Holland: Promotion of sustainable employability Door de verhoogde pensioenleeftijd wordt duurzame inzetbaarheid van werknemers steeds …

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The Timing and Effort of Lexical Access in Natural and Degraded Speech.

The Timing and Effort of Lexical Access in Natural and Degraded Speech.

Front Psychol. 2016;7:398

Authors: Wagner AE, Toffanin P, Başkent D

Abstract
Understanding speech is effortless in ideal situations, and although adverse conditions, such as caused by hearing impairment, often render it an effortful task, they do not necessarily suspend speech comprehension. A prime example of this is speech perception by cochlear implant users, whose hearing prostheses transmit speech as a significantly degraded signal. It is yet unknown how mechanisms of speech processing deal with such degraded signals, and whether they are affected by effortful processing of speech. This paper compares the automatic process of lexical competition between natural and degraded speech, and combines gaze fixations, which capture the course of lexical disambiguation, with pupillometry, which quantifies the mental effort involved in processing speech. Listeners’ ocular responses were recorded during disambiguation of lexical embeddings with matching and mismatching durational cues. Durational cues were selected due to their substantial role in listeners’ quick limitation of the number of lexical candidates for lexical access in natural speech. Results showed that lexical competition increased mental effort in processing natural stimuli in particular in presence of mismatching cues. Signal degradation reduced listeners’ ability to quickly integrate durational cues in lexical selection, and delayed and prolonged lexical competition. The effort of processing degraded speech was increased overall, and because it had its sources at the pre-lexical level this effect can be attributed to listening to degraded speech rather than to lexical disambiguation. In sum, the course of lexical competition was largely comparable for natural and degraded speech, but showed crucial shifts in timing, and different sources of increased mental effort. We argue that well-timed progress of information from sensory to pre-lexical and lexical stages of processing, which is the result of perceptual adaptation during speech development, is the reason why in ideal situations speech is perceived as an undemanding task. Degradation of the signal or the receiver channel can quickly bring this well-adjusted timing out of balance and lead to increase in mental effort. Incomplete and effortful processing at the early pre-lexical stages has its consequences on lexical processing as it adds uncertainty to the forming and revising of lexical hypotheses.

PMID: 27065901 [PubMed]

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Ammonium across a Selective Polymer Inclusion Membrane: Characterization, Transport, and Selectivity.

Ammonium across a Selective Polymer Inclusion Membrane: Characterization, Transport, and Selectivity.

Macromol Rapid Commun. 2016 Apr 8;

Authors: Casadellà A, Schaetzle O, Loos K

Abstract
The recovery of ammonium from urine requires distinguishing and excluding sodium and potassium. A polymer inclusion membrane selective for ammonium is developed using an ionophore based on pyrazole substituted benzene. The interactions of the components are studied, as well as their effect on transport and selectivity. Spectroscopic and thermogravimetric measurements show no extensive physical interactions of the components, and that the plasticizer reduces the intermolecular forces (rigidity) of the membrane. The ionophore turns the membrane more rigid, although it increases its swelling degree and therefore the affinity of cations. A ratio of plasticizer (DEHP) and polymer (PVC) of 1:3 in mass gives the highest ammonium flux. Tested contents of ionophore (2 and 5 wt%) show that the higher the content of the ionophore, the fastest the flux is (7.5 × 10(-3) mmol cm(-2) h(-1) ). Selectivity of NH4 (+) over Na(+) and over K(+) is reduced from 13.07 to 9.33 and from 14.15 to 9.57 correspondingly.

PMID: 27062504 [PubMed – as supplied by publisher]

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Triage bij psychische klachten in de huisartsenpraktijk : Onderzoek naar het gebruik van een beslismodel voor het gericht verwijzen van patiënten met psychische problematiek

Background: Since 2014, general practitioners (GPs) in The Netherlands can refer patients to mental health care only if the patient has a disorder that meets the DSM classification. Consequently a selection has to be made, to determine whether a patient will be treated within general practice or if the patient gets a referral. To assist the General practitioner in this selection process a decision-model has been developed that combines outcomes of the Four-Dimensional Symptom Questionnaire (4DSQ) with criteria developed to distinguish between generalist basic mental health care and specialized mental health care (HHM-criteria). The aim of this study was to determine whether this decision-model is suitable for targeted referral of patients with mental problems.
Method: 408 patients with probable mental problems attending in 2014 a large general practice completed the 4DSQ at baseline and after three months in order to assess the effect of the treatment. The GP completed the HHM-criteria at baseline. The first 4DSQ combined with the HHM-criteria resulted in an indication for a treatment setting. This indication was compared to the actual place where the patient had been treated. In that way it could be decided if patients were treated following the outcome of triage or on a lower or higher level than indicated.
Results: After three months 4DSQ-scores decreased in every treatment setting on each dimension. After controlling for baseline scores, there was no difference in decrease between treatment settings. Patients who received less intensive care than necessary booked comparable progress on the various dimensions of the 4DSQ than patients who were treated according to triage criteria. These results were maintained over alternative interpretations of the 4DSQ.
Practice implications: This study showed that patients treated by GPs and practice mental healthcare workers had a similar reduction in symptoms as patients treated in the generalist basic mental health care and specialized mental health care setting, even patients with severe problems. However, this study was no experimental trial, but a naturalistic study. GPs could keep patients in general practice not requiring further intervention according to his clinical judgment. If follow-up studies demonstrate comparable results, general practice mental healthcare workers will be a good addition to the secondary mental health care.
Conclusion: A randomized trial is required to give a thorough answer to the question whether the 4DSQ is a great addition to the already deployed HHM criteria.

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Triage bij psychische klachten in de huisartsenpraktijk : Onderzoek naar het gebruik van een beslismodel voor het gericht verwijzen van patiënten met psychische problematiek

Background: Since 2014, general practitioners (GPs) in The Netherlands can refer patients to mental health care only if the patient has a disorder that meets the DSM classification. Consequently a selection has to be made, to determine whether a patient will be treated within general practice or if the patient gets a referral. To assist the General practitioner in this selection process a decision-model has been developed that combines outcomes of the Four-Dimensional Symptom Questionnaire (4DSQ) with criteria developed to distinguish between generalist basic mental health care and specialized mental health care (HHM-criteria). The aim of this study was to determine whether this decision-model is suitable for targeted referral of patients with mental problems.
Method: 408 patients with probable mental problems attending in 2014 a large general practice completed the 4DSQ at baseline and after three months in order to assess the effect of the treatment. The GP completed the HHM-criteria at baseline. The first 4DSQ combined with the HHM-criteria resulted in an indication for a treatment setting. This indication was compared to the actual place where the patient had been treated. In that way it could be decided if patients were treated following the outcome of triage or on a lower or higher level than indicated.
Results: After three months 4DSQ-scores decreased in every treatment setting on each dimension. After controlling for baseline scores, there was no difference in decrease between treatment settings. Patients who received less intensive care than necessary booked comparable progress on the various dimensions of the 4DSQ than patients who were treated according to triage criteria. These results were maintained over alternative interpretations of the 4DSQ.
Practice implications: This study showed that patients treated by GPs and practice mental healthcare workers had a similar reduction in symptoms as patients treated in the generalist basic mental health care and specialized mental health care setting, even patients with severe problems. However, this study was no experimental trial, but a naturalistic study. GPs could keep patients in general practice not requiring further intervention according to his clinical judgment. If follow-up studies demonstrate comparable results, general practice mental healthcare workers will be a good addition to the secondary mental health care.
Conclusion: A randomized trial is required to give a thorough answer to the question whether the 4DSQ is a great addition to the already deployed HHM criteria.

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The blood pressure response in children with normal hearts at peak exercise

Introduction
Exercise tests are very useful in the treatment and follow-up of heart diseases. Problems in
the cardiovascular system are the most common congenital abnormalities with an overall
20-year survival rate of 89.5%. A good follow-up during this time is important and exercise
test form part of this. Nevertheless, in children a standard for blood pressure response
during exercise has not been developed yet. This is an important omission since this
response is used to guide therapy in several cardiac conditions. This study aims to make a
first step towards such a standard for blood pressure response.
Methods
The data of 133 children are included ranging in age from four to eighteen. These
comprise 68 (51 %) boys and 65 (49 %) girls. All participants underwent a treadmill
exercise test according to the Bruce protocol. Before and during the exercise the heart
rate and blood pressure were measured. Also, data on the height, weight, age of every
participant were collected. To be included participants had to reach peak heart rate,
which was defined as achieving 85% of their maximum heart rate (calculated with the
formula 210 – 0.65 x the age of the subject (years) and determined after the exercise
test). The data have been tested on correlation (R2) and the p – values have been
calculated with an one-way ANOVA test.
Results
Systolic blood pressure appeared to be a suitable parameter to measure blood response
during exercise; diastolic blood pressure did not show clear responses. Systolic blood
pressure was positively correlated with age at rest and during peak exercise. Age is
widely used as a parameter to describe systolic (and diastolic) blood pressure at rest in
adults and, to a lesser extent, in children.
Systolic blood pressure at peak exercise was positively correlated with biometrical
parameters (height, weight, BMI and BSA). Of these BSA (Mosteller) appeared to
have the strongest correlation with peak systolic blood pressure in males, females, and
males and females combined (R2 = 0.2578, 0.3636, 0.3017 respectively). For the
development of a standard for the blood pressure response to exercise in children, age
and BSA (Mosteller) appeared the most suitable parameters. Thus, peak systolic
blood pressure (mean ± 2sd) has been plotted against age and against BSA (Mosteller)
for males, females, and males and females.
Conclusion
This study showed some promising results on the blood pressure response during
exercise. This study indicates that systolic blood pressure versus age and systolic
blood pressure versus BSA give good correlations and might be good parameters for
future guidelines.

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The blood pressure response in children with normal hearts at peak exercise

Introduction
Exercise tests are very useful in the treatment and follow-up of heart diseases. Problems in
the cardiovascular system are the most common congenital abnormalities with an overall
20-year survival rate of 89.5%. A good follow-up during this time is important and exercise
test form part of this. Nevertheless, in children a standard for blood pressure response
during exercise has not been developed yet. This is an important omission since this
response is used to guide therapy in several cardiac conditions. This study aims to make a
first step towards such a standard for blood pressure response.
Methods
The data of 133 children are included ranging in age from four to eighteen. These
comprise 68 (51 %) boys and 65 (49 %) girls. All participants underwent a treadmill
exercise test according to the Bruce protocol. Before and during the exercise the heart
rate and blood pressure were measured. Also, data on the height, weight, age of every
participant were collected. To be included participants had to reach peak heart rate,
which was defined as achieving 85% of their maximum heart rate (calculated with the
formula 210 – 0.65 x the age of the subject (years) and determined after the exercise
test). The data have been tested on correlation (R2) and the p – values have been
calculated with an one-way ANOVA test.
Results
Systolic blood pressure appeared to be a suitable parameter to measure blood response
during exercise; diastolic blood pressure did not show clear responses. Systolic blood
pressure was positively correlated with age at rest and during peak exercise. Age is
widely used as a parameter to describe systolic (and diastolic) blood pressure at rest in
adults and, to a lesser extent, in children.
Systolic blood pressure at peak exercise was positively correlated with biometrical
parameters (height, weight, BMI and BSA). Of these BSA (Mosteller) appeared to
have the strongest correlation with peak systolic blood pressure in males, females, and
males and females combined (R2 = 0.2578, 0.3636, 0.3017 respectively). For the
development of a standard for the blood pressure response to exercise in children, age
and BSA (Mosteller) appeared the most suitable parameters. Thus, peak systolic
blood pressure (mean ± 2sd) has been plotted against age and against BSA (Mosteller)
for males, females, and males and females.
Conclusion
This study showed some promising results on the blood pressure response during
exercise. This study indicates that systolic blood pressure versus age and systolic
blood pressure versus BSA give good correlations and might be good parameters for
future guidelines.

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Het aanleren van inhaleren bij patiënten met astma en COPD: kan het beter? : Een onderzoek naar verschillende manieren van inhalatie-instructie voorhet aanleren van correct gebruik van inhalatiemedicatie bij patiënten met astma of COPD

Background: Inhaled mediation is the cornerstone of the management of asthma and COPD. Adequate inhaler technique is crucial to maximise the benefits of inhaled medication treatment. However, inadequate inhaler technique is a common and widespread issue. Although inhaler education has been shown to improve outcomes, research into the most optimal method or content of inhaler education is scarce. The newly developed inhaler-specific patient instruction cards might have an additional value in optimising inhaler technique. This study evaluates the inhaler technique in patients with asthma or COPD visiting the outpatient department of Pulmonary Diseases of the Martini Hospital and
to investigate the additional value of the use of inhaler-specific instruction cards.
Methods: Prospective randomised controlled trial in 100 patients with asthma or COPD. Patients are randomly assigned to either the usual care group (receiving standard inhaler education) or the usual care + group (receiving a patient instruction card additional to the standard inhaler education). Inhaler technique is assessed using an inhaler-specific checklist at baseline and at follow-up (6-8 weeks later). In addition, patients in both groups fill out questionnaires asking for symptoms, adherence, patient perceived side effects and satisfaction. Results: At baseline only 8% of the patients demonstrated adequate inhaler technique. An improvement in inhaler technique was found at follow up (70% correct). The improvement found in the usual care+ group was significantly (P<0.001) higher as compared to the improvement in the usual care group (respectively from 4% to 85% (P<0.001) and from 12% to 57% (P<0.001)). Conclusion: Improper use of inhaled medication is common in patients with asthma or COPD. This study emphasises the need of more awareness for regular monitoring of the inhaler technique and providing inhaler instruction. The newly developed inhaler-specific instruction card might be a helpful tool in optimising inhaler technique.

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First in-human intraoperative optical imaging of peritoneal carcinomatosis of colorectal origin using the VEGF-targeted near-infrared fluorescent tracerbevacizumab-IRDye800CW: a feasibility study. HI-LIGHT study, NL45588-042-13

Introduction
Optimal cytoreduction (CRS) in addition to Hyperthermic IntraPEritoneal Chemotherapy
(HIPEC) is essential for the curative treatment of peritoneal carcinomatosis (PC) of colorectal
origin. Currently, differentiation between benign and malignant lesions can be very difficult
and the diagnostic accuracy profile of tactile and visual inspection remains unknown. Better
tumor detection could lead to improved radical cytoreduction. In this study we used nearinfrared
fluorescence (NIRF) imaging to enhance surgical vision.
Methods
Patients scheduled for CRS and HIPEC were included in this feasibility study (n=7). The
NIRF tracer bevacizumab-IRDye800CW targeting VEGF-A was administered intravenously
two days prior to surgery. After exposure of the abdominal cavity, two surgeons
independently calculated the peritoneal cancer index (PCI) first by inspection and palpation,
subsequently using the NIR intraoperative camera system. Biopsies were taken from
fluorescent and non-fluorescent areas for ex-vivo validation and correlation of fluorescence.
Results
No (serious) adverse events related to tracer administration occurred in any of the seven
patients. In total 87 peritoneal lesions were imaged and histologically analyzed. In 31 out of
58 fluorescent lesions cancerous cells were detected during histopathological analysis. All 23
non-fluorescent lesions were cancer negative, indicating a sensitivity of 100%. Additionally,
in two patients this method detected cancerous tissue that was otherwise missed by inspection
and palpation alone. In one patient this concerned a positive resection margin and in another
patient a para-aortal lymph node metastasis was detected. Despite the relatively high false
positive rate (47%), the PCI decreased 2.9 points on average per patient. Most false positive
lesions appeared to be highly fibrotic and vascularized lesions or foreign inclusion bodies
such as suturing material from previous surgery. Fluorescence was strongly correlated with
vital tumor tissue ex-vivo at a microscopic level, with a tumor-to-normal ratio of 6,92 ± 2,47
(mean ± sd).
Conclusion
Intraoperative NIRF-imaging of PC during CRS is technically feasible and safe. This highly
sensitive technique can lead to a more optimal cytoreduction by leaving suspicious lesions
that are not fluorescent in situ. Moreover, stage migration might occur due to better patient
selection, possibly enabling more patients to benefit from the curative CRS and HIPEC
procedure. Therefore, this technique has to potential to prevent both over and under treatment.
Additionally, NIRF-imaging enables the evaluation of possible positive resection margins,
which might be of use in the treatment of locally advanced rectal cancer. We state that these
preliminary results are promising for a subsequent phase II study.

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