HAN University of Applied Sciences

Unintentional weight loss (UWL) is an important clinical indicator of malnutrition risk. Risk factors for UWL may differ by body size, measured by body mass index (BMI), and identifying at-risk individuals can be challenging in those with overweight/obesity. Data from ∼125 000 adults (≥18 y) in the Dutch Lifelines cohort were analyzed to examine whether associations between 21 potential risk factors spanning sociodemographic, psychological stress, disease, dietary, and quality-of-life domains and UWL differ by BMI group. Participants were classified as having a healthy weight (45.8%) or overweight/obesity (54.2%). Multivariable Poisson regression models estimated prevalence ratios for UWL, with sensitivity analyses to test robustness. Statistical significance was set at P < 0.05. UWL was reported by 4.9% of participants with a healthy weight and 2.7% of those with overweight/obesity. Positive associations with UWL were observed for female sex, (healthy-weight group only), absence from work due to disease, psychological stress in the past year, chronic obstructive pulmonary disease, depression, and poor quality-of-life indicators (physical functioning, perceived health, emotional well-being, vitality, and social functioning). Effect modification by BMI was suggested for 10 risk factors (P < 0.1), with associations generally more pronounced in the healthy-weight group. After sensitivity analyses, only higher educational attainment, psychological stress in the past year, and poor physical functioning retained significant modification. Most risk factors for UWL were consistent between BMI groups. Differences in higher educational attainment, psychological stress in the past year, and physical functioning suggest that although the factors are similar, their impact may differ by BMI.

Dental education prepares students for independent practice, handling both predictable and unpredictable challenges. This necessitates a prospective approach to supervision and assessment, as such an approach not only evaluates current performance but also anticipates future behaviour. Entrustable Professional Activities (EPAs) offer a structured framework to develop and assess trust in students, supporting this prospective perspective. Although EPAs were originally designed for postgraduate training, they are increasingly used in undergraduate programs. While existing literature outlines factors influencing entrustment decisions, little is known about how these factors operate within dental education. This study explores how entrustment is enacted in dentistry and examines its potential link to adaptive expertise, which further promotes a prospective approach to supervision and assessment. A focused ethnography was conducted to gain in-depth insight into entrustment decision-making, based on observations and interviews during clinical practice and academic clinical reasoning sessions, and interviews reflecting on these observations. Data collection was followed by template analysis, using a theoretical background based on literature on ad hoc and summative entrustment decisions, retrospective and prospective entrustment, the A RICH framework, and conceptualisations and operationalisations of adaptive expertise. Throughout every phase of the study, an iterative process took place involving the entire research team. Data collection involved 56 h of observations and 9 interviews with dental supervisors. Ad hoc entrustment decisions are made daily by supervisors. All factors known from the literature to influence entrustment decisions were observed, including the A RICH features of students and students’ adaptive expertise and adaptive performance. The patient as an actor emerged as an additional factor influencing entrustment. This study highlights the increasing applicability of EPAs in dental education. It confirms the factors influencing entrustment decisions, adds the patient as a sixth factor, and supports the relevance of the A RICH framework. The findings emphasize a paradigm shift toward trust-based dialogue. However, conversations about entrustment rarely address trainee qualities beyond technical skills explicitly. To enable prospective assessment, curriculum design is crucial: a longitudinal EPA-based curriculum provides essential conditions for supervisors’ entrustment decisions. Further research into key curriculum factors is important to facilitate EPA-based curricula in dental education.

Occupational health professionals (OHPs) collaborate to support return to work (RTW) for employees on long-term sick leave, but differences in roles and perspectives can result in inconsistent work ability assessments. To promote a shared understanding of work ability, the ICF(International Classification of Functioning, Disability, and Health)-based Work Ability & Reintegration Description (WARD) instrument was developed. This study evaluated its psychometric properties, in particular criterion validity and reliability. A mixed-methods study was conducted in three phases. Firstly, a reference standard set for assessing work ability in 10 case vignettes was established employing the Modified Delphi method with nine OHPs. Secondly, 22 OHPs independently assessed work ability with the WARD-instrument, for which overall agreement with the reference standard, and inter-rater reliability were calculated. Thirdly, a focus group with eight OHPs explored sources of variation for assessing work ability with WARD. Agreement with the reference standard ranged from 58.6% to 99.5%. High agreement (> 70%) was found for 23 out of 29 items. Specificity (59.7%-99.5%) generally exceeded sensitivity (18.2%-95.5%), indicating greater consistency in ruling out non-relevant items than in identifying relevant ones. Focus group discussions emphasized that assessments should be context-dependent to support rehabilitation purposes. The WARD-instrument shows promising criterion validity and reliability, especially for objectifiable and physical aspects of functioning. More complex and context-dependent domains, such as cognitive aspects of functioning and personal factors, remain challenging to consistently assess among different OHPs. Its focus on identifying context-sensitive RTW barriers may support more person-centered sick leave guidance. Further research in real-life practice is needed to strengthen validation and guide implementation.

Ribosomes are responsible for protein synthesis in all living systems. Determining their cellular organization, movement, and translational activity is crucial for dissecting ribosomes' complex functions. In this study, we describe the development of a selective fluorescent probe for eukaryotic ribosomes - RiboBright. Using C-H activation, the natural product cycloheximide was aminated at the C13-position and fluorescently modified to afford RiboBright. We employ RiboBright for the quantification of ribosome content in 10 cell lines through microscopy and flow cytometry. RiboBright is applicable in live cells for tracking and quantification of ribosome movement and in fixed cells for visualization of sub-micrometer-sized spots, at the single-cell level. RiboBright reveals lineage-specific ribosome content, organization, and movement upon differentiation into either extraembryonic endoderm or ectoderm-like cells. Thus, RiboBright provides a versatile and convenient approach for imaging the cellular dynamics of ribosomes.

<title>Abstract</title> Heat-related mortality during extreme heat events exhibits delayed, non-linear dynamics that cannot be explained by static environmental thresholds or simple cumulative exposure metrics alone. This paper introduces <bold>PYROX</bold> (Populational Yield for Relative Outdoor eXposure), a control-theory-inspired framework that models human heat stress response as a cascaded dual-process system with <bold>bidirectional feedback</bold> . The model formalizes the dynamic interaction between <bold>short-term physiological acclimatization (α)</bold> and <bold>cumulative physiological strain (Σ)</bold> , coupling them through a closed loop in which accumulated strain progressively suppresses acclimatization capacity, and diminished acclimatization in turn increases the rate of strain accumulation. This mutual feedback creates a non-linear instability mechanism. Using a discrete-time formulation, I demonstrate the existence of a <bold>critical strain threshold (Σ_critical)</bold> beyond which adaptation collapses and the system becomes unstable, leading to runaway decompensation under continued exposure. Analytical stability analysis shows this threshold emerges as a mathematical property of the feedback structure. The framework provides a mechanistic explanation for delayed mortality peaks and abrupt health deterioration during prolonged heatwaves. It enables explicit prediction of <bold>intervention windows</bold> , <bold>time-to-critical transitions</bold> , and <bold>population-specific vulnerability</bold> , offering a dynamic alternative to current heat-health warning systems.

Non-specific low back pain (NSLBP) is the leading cause of global disability, and self-management is considered a key component of care. However, physiotherapists' approaches to supporting self-management can be improved. To explore how Italian physiotherapists conceptualize and enact self-management support for non-specific low back pain, and to describe perceived barriers and enablers to its implementation in routine practice. An online SurveyMonkey questionnaire was administered in February 2024 to assess Italian physiotherapists' knowledge and experience with self-management strategies for NSLBP. The survey consisted of 15 open-ended questions adapted from a Dutch study. Responses were analysed using inductive thematic analysis. Thirty physiotherapists (21 female, mean age 30.4±8.7 years) participated. Four themes emerged: (1) Therapeutic interaction style: active, passive, or multimodal?; (2) The patient as the main actor; (3) Self-management as more than a single tool; and (4) The physiotherapist's role in the self-management journey. Most participants viewed self-management support as essential and commonly used education as their primary strategy, while recognising its limitations. Although a variety of treatment approaches was reported, many remained grounded in biomechanical reasoning. A majority expressed the need for further knowledge and skills to better support self-management. Most participants recognised the importance of self-management in treating NSLBP but did not fully align with its core principles. Although they emphasised patient-focused, person-centred care, it remains unclear whether these principles are truly applied. Over half indicated a need for additional skills, consistent with broader challenges physiotherapists face in integrating self-management strategies.

Purpose To assess French- and Dutch-speaking physiotherapists’ knowledge, practices, and acceptance of immersive virtual reality (VR) in clinical settings. Materials and methods A cross-sectional online survey (NCT06252363) was conducted from February to July 2024, targeting French- and Dutch-speaking physiotherapists via non-probability sampling methods. Data were analyzed descriptively. Results A total of 155 physiotherapists from eight countries participated, mostly from Belgium. Most (75.5%) had never used immersive VR, while 12.25% were current users and 12.25% past users. Physiotherapists generally demonstrated satisfactory knowledge of immersive VR. Key facilitators and barriers to usage, reasons for discontinuation, and factors contributing to nonuse were identified. Half of the never-users showed interest in future use, a minority of past users planned to resume, and nearly all current users intended to continue. Attitudes toward immersive VR were mostly positive, though concerns about cost and value for money were noted. Immersive VR was generally perceived as clinically useful and not overly complex. Social influence did not appear to be a key factor in its adoption. Conclusions These findings provide insights into the perspectives of French- and Dutch-speaking physiotherapists regarding the use of immersive VR in clinical settings and may help inform the development of implementation strategies targeting physiotherapists.

PurposeWorldwide, the COVID-19 pandemic disrupted access to primary care and rehabilitation services, leaving many non-hospitalized patients with persistent symptoms unsure where to seek support. Primary allied health care (pAHP) became an important source of guidance and rehabilitation in several countries. This qualitative study explored how pAHP was accessed, experienced, and delivered in the Netherlands during the early stages of the pandemic, focusing on non-hospitalized patients with lingering symptoms following SARS-CoV-2 infection and the allied health professionals who supported them.MethodsA qualitative study was conducted in the Netherlands between January and May 2021. Semi-structured interviews were held with 11 non-hospitalized patients and 30 primary allied health care professionals across five disciplines. Participants reflected on their experiences with primary allied health care during the first year of the pandemic. Data were analyzed using inductive thematic analysis.ResultsThree main themes described this period: (1) navigating uncertainty in the absence of guidelines and knowledge about the disease; (2) adapting care, balancing treatment content and delivery; and (3) forging connections, including interprofessional collaboration and organization in primary care. Patients generally reported positive experiences and valued feeling heard and supported, while professionals described adaptive strategies and organizational challenges.ConclusionsPrimary allied healthcare played a valued and adaptive role for non-hospitalized patients during the early pandemic. These findings underscore the importance of acknowledging patients’ symptoms, strengthening interprofessional collaboration, and supporting flexible, evidence-informed care strategies to prepare primary care systems for future health crises.

Limited health literacy (LHL) can affect the ability to understand and apply health information. For patients with rotator cuff tears, following post-treatment guidelines is crucial for recovery. However, existing resources often don't meet the needs of those with LHL, potentially delaying recovery. This study investigates the prevalence of LHL in patients with rotator cuff tears, the challenges in managing health information, and possible strategies to improve care. The prevalence of LHL in patients with rotator cuff tears was assessed using the Single-Item Literacy Screener. To explore the challenges in managing health information and possible solutions, semistructured interviews based on the Health Literacy Questionnaire were conducted with twelve patients. Data were collected through audio recordings and field notes, which were transcribed and analyzed using thematic analysis. The prevalence of LHL in patients contacted by phone was 9.3% and 40.7% when contacted at the outpatient clinic. Patients experienced significant language barriers in health care communication, challenges in finding and evaluating relevant health information. These patients reported diverse and specific needs for tailored health information. They suggested using formats that cater to their preferences and sought support from their social networks to better manage their condition and treatment journey. This study adds to the evidence that LHL is common and associated with multiple challenges in health care engagement. Addressing these challenges through personalized, accessible communication strategies, in combination with support from their social environment, should be a priority for health care systems aiming to reduce inequalities and improve patient outcomes in patients with rotator cuff tears.