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Digital skills : unlocking the information society
\"Digital Skills systematically discusses the skills or literacies needed in the use of digital media, primarily computers and the Internet. Following the work of van Dijk's, The Deepening Divide: Inequality in the Information Society, it uses conceptual analysis and empirical observations to show what digital skills are, how they are distributed, how skill inequalities develop, and how these inequalities can be remedied by designers, educators, policymakers, and different types of Internet users\"-- Provided by publisher.
Book
Intraoperative electrocorticography using high-frequency oscillations or spikes to tailor epilepsy surgery in the Netherlands (the HFO trial): a randomised, single-blind, adaptive non-inferiority trial
Intraoperative electrocorticography is used to tailor epilepsy surgery by analysing interictal spikes or spike patterns that can delineate epileptogenic tissue. High-frequency oscillations (HFOs) on intraoperative electrocorticography have been proposed as a new biomarker of epileptogenic tissue, with higher specificity than spikes. We prospectively tested the non-inferiority of HFO-guided tailoring of epilepsy surgery to spike-guided tailoring on seizure freedom at 1 year.
The HFO trial was a randomised, single-blind, adaptive non-inferiority trial at an epilepsy surgery centre (UMC Utrecht) in the Netherlands. We recruited children and adults (no age limits) who had been referred for intraoperative electrocorticography-tailored epilepsy surgery. Participants were randomly allocated (1:1) to either HFO-guided or spike-guided tailoring, using an online randomisation scheme with permuted blocks generated by an independent data manager, stratified by epilepsy type. Treatment allocation was masked to participants and clinicians who documented seizure outcome, but not to the study team or neurosurgeon. Ictiform spike patterns were always considered in surgical decision making. The primary endpoint was seizure outcome after 1 year (dichotomised as seizure freedom [defined as Engel 1A–B] vs seizure recurrence [Engel 1C–4]). We predefined a non-inferiority margin of 10% risk difference. Analysis was by intention to treat, with prespecified subgroup analyses by epilepsy type and for confounders. This completed trial is registered with the Dutch Trial Register, Toetsingonline ABR.NL44527.041.13, and ClinicalTrials.gov, NCT02207673.
Between Oct 10, 2014, and Jan 31, 2020, 78 individuals were enrolled to the study and randomly assigned (39 to HFO-guided tailoring and 39 to spike-guided tailoring). There was no loss to follow-up. Seizure freedom at 1 year occurred in 26 (67%) of 39 participants in the HFO-guided group and 35 (90%) of 39 in the spike-guided group (risk difference –23·5%, 90% CI –39·1 to –7·9; for the 48 patients with temporal lobe epilepsy, the risk difference was –25·5%, –45·1 to –6·0, and for the 30 patients with extratemporal lobe epilepsy it was –20·3%, –46·0 to 5·4). Pathology associated with poor prognosis was identified as a confounding factor, with an adjusted risk difference of –7·9% (90% CI –20·7 to 4·9; adjusted risk difference –12·5%, –31·0 to 5·9, for temporal lobe epilepsy and 5·8%, –7·7 to 19·5, for extratemporal lobe epilepsy). We recorded eight serious adverse events (five in the HFO-guided group and three in the spike-guided group) requiring hospitalisation. No patients died.
HFO-guided tailoring of epilepsy surgery was not non-inferior to spike-guided tailoring on intraoperative electrocorticography. After adjustment for confounders, HFOs show non-inferiority in extratemporal lobe epilepsy. This trial challenges the clinical value of HFOs as an epilepsy biomarker, especially in temporal lobe epilepsy. Further research is needed to establish whether HFO-guided intraoperative electrocorticography holds promise in extratemporal lobe epilepsy.
UMCU Alexandre Suerman, EpilepsieNL, RMI Talent Fellowship, European Research Council, and MING Fund.
Journal Article
ضد الانتخابات : دفاعا عن الديمقراطية
يثير هذا الكتاب تساؤلات عدة عن ماهية الديمقراطية وإن كانت الإنتخابات وسيلة حقيقية لتحقيق الديمقراطية بالفعل فى العالم بأكمله أم لا ومن بينها تأتى الديكتاتورية دائما عن طريق الانتخابات مثل هتلر وستالين فهل الإنتخابات تؤدي دائما إلى الديمقراطية أم لا ويناقش الكاتب فكرة أن هناك شيئا غير مألوف يرتبط بالديمقراطية دائما فالكل يأمل فى تحقيق الديمقراطية بشكل حقيقي وفى الوقت نفسه لا يؤمن بها أحد على الإطلاق حتى لو أشارت الإحصائيات العالمية إلى أن الغالبية العظمى من الناس يفضلون تحقيق الديمقراطية.
BOOK
Integrated use of minimal residual disease classification and IKZF1 alteration status accurately predicts 79% of relapses in pediatric acute lymphoblastic leukemia
Response to therapy as determined by minimal residual disease (MRD) is currently used for stratification in treatment protocols for pediatric acute lymphoblastic leukemia (ALL). However, the large MRD-based medium risk group (MRD-M; 50–60% of the patients) harbors many relapses. We analyzed MRD in 131 uniformly treated precursor-B-ALL patients and evaluated whether combined MRD and
IKZF1
(Ikaros zinc finger-1) alteration status can improve risk stratification. We confirmed the strong prognostic significance of MRD classification, which was independent of
IKZF1
alterations. Notably, 8 of the 11 relapsed cases in the large MRD-M group (
n
=81; 62%) harbored an
IKZF1
alteration. Integration of both MRD and
IKZF1
status resulted in a favorable outcome group (
n
=104; 5 relapses) and a poor outcome group (
n
=27; 19 relapses), and showed a stronger prognostic value than each of the established risk factors alone (hazard ratio (95%CI): 24.98 (8.29–75.31)). Importantly, whereas MRD and
IKZF1
status alone identified only 46 and 54% of the relapses, respectively, their integrated use allowed prediction of 79% of all the relapses with 93% specificity. Because of the unprecedented sensitivity in upfront relapse prediction, the combined parameters have high potential for future risk stratification, particularly for patients originally classified as non-high risk, such as the large group of MRD-M patients.
Journal Article
Uh-Oh Octopus!
When a small octopus arrives home one day to find an intruder barricading his entrance, he asks other sea creatures for advice on what to do about the situation.
Book
Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia
This multicenter, randomized trial of hypoglycemia treatment in otherwise healthy newborns at risk for hypoglycemia compared cognitive and motor outcome scores at 18 months for a traditional treatment threshold (glucose concentration of <47 mg per deciliter) and a lower threshold (glucose concentration of <36 mg per deciliter). The lower threshold was noninferior to the traditional threshold.
Journal Article
الأرنب ريكي
يتناول الكتاب ثلاثة قصص متعة للنظر وبديعة الصور ومخصصة للأطفال في مرحلة ما قبل الإبتدائية ويفرحون إذا فرح ريكي ويحزنون إذا حزن ريكي ويكتشفون معان مختلفة للحياة ومع كل مغامرة لغز وأسرار والقصة الأولى \"الأرنب ريكي\" في الغابة أرانب سمينة وأرنب نحيلة وأرانب ذكية وأرانب غبية وأرانب شجاعة وأرانب جبانة وأرانب إناث وأرانب ذكور ولكنها كلها تملك آذانا طويلة والقصة الثانية \"ريكي يلعب مع أصدقائه\" كل مساء يذهب ريكي إلى الغابة ويمضي وقته في الهواء الطلق وكان يحب اللعب مع أصدقائه الأرانب والبيضاء والرمادية والبنية والسوداء والقصة الثالثة \"حفلة ريكي\" هذا اليوم مميز جدا، فاليوم حفلة ريكي لذا نهض ريكي من نومه باكرا، وبدأ بمساعدة أمه في الأعداد لحفلته ولكن عندما وصل أصدقاؤه أخيرا لم تكن \"لالا\" برفقتهم وأين هي يا ترى؟ وهل يخبئ هذا اليوم المزيد من المفاجآت لريكي؟ قصة مصورة وممتعة للأطفال في سن الرابعة وما فوق وتدور حول حفلة ريكي.
Book
IKZF1 deletions predict relapse in uniformly treated pediatric precursor B-ALL
Relapse is the most common cause of treatment failure in pediatric acute lymphoblastic leukemia (ALL) and is often difficult to predict. To explore the prognostic impact of recurrent DNA copy number abnormalities on relapse, we performed high-resolution genomic profiling of 34 paired diagnosis and relapse ALL samples. Recurrent lesions detected at diagnosis, including
PAX5
,
CDKN2A
and
EBF1
, were frequently absent at relapse, indicating that they represent secondary events that may be absent in the relapse-prone therapy-resistant progenitor cell. In contrast, deletions and nonsense mutations in
IKZF1
(
IKAROS
) were highly enriched and consistently preserved at the time of relapse. A targeted copy number screen in an unselected cohort of 131 precursor B-ALL cases, enrolled in the dexamethasone-based Dutch Childhood Oncology Group treatment protocol ALL9, revealed that
IKZF1
deletions are significantly associated with poor relapse-free and overall survival rates. Separate analysis of ALL9-treatment subgroups revealed that non-high-risk (NHR) patients with
IKZF1
deletions exhibited a ∼12-fold higher relative relapse rate than those without
IKZF1
deletions. Consequently,
IKZF1
deletion status allowed the prospective identification of 53% of the relapse-prone NHR-classified patients within this subgroup and, therefore, serves as one of the strongest predictors of relapse at the time of diagnosis with high potential for future risk stratification.
Journal Article
The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes
PurposeHybrid image-guided surgery technologies such as combined radio- and fluorescence-guidance are increasingly gaining interest, but their added value still needs to be proven. In order to evaluate if and how fluorescence-guidance can help realize improvements beyond the current state-of-the-art in sentinel node (SN) biopsy procedures, use of the hybrid tracer indocyanine green (ICG)-99mTc-nancolloid was evaluated in a large cohort of patients.Patients and methodsA prospective trial was conducted (n = 501 procedures) in a heterogeneous cohort of 495 patients with different malignancies (skin malignancies, oral cavity cancer, penile cancer, prostate cancer and vulva cancer). After injection of ICG-99mTc-nanocolloid, SNs were preoperatively identified based on lymphoscintigraphy and SPECT/CT. Intraoperatively, SNs were pursued via gamma tracing, visual identification (blue dye) and/or near-infrared fluorescence imaging during either open surgical procedures (head and neck, penile, vulvar cancer and melanoma) or robot assisted laparoscopic surgery (prostate cancer). As the patients acted as their own control, use of hybrid guidance could be compared to conventional radioguidance and the use of blue dye (n = 300). This was based on reported surgical complications, overall survival, LN recurrence free survival, and false negative rates (FNR).ResultsA total of 1,327 SN-related hotspots were identified on 501 preoperative SPECT/CT scans. Intraoperatively, a total number of 1,643 SNs were identified based on the combination of gamma-tracing (>98%) and fluorescence-guidance (>95%). In patients wherein blue dye was used (n = 300) fluorescence-based SN detection was superior over visual blue dye-based detection (22–78%). No adverse effects related to the use of the hybrid tracer or the fluorescence-guidance procedure were found and outcome values were not negatively influenced.ConclusionWith ICG-99mTc-nanocolloid, the SN biopsy procedure has become more accurate and independent of the use of blue dye. With that, the procedure has evolved to be universal for different malignancies and anatomical locations.
Journal Article