Rules of consultation. Parliamentary procedure in the Netherlands since 1795

Politics, Culture and National Identities 1789-presen

Combining unequal variance signal detection theory with the health belief model to optimize shared decision making in tinnitus patients: part 1-model development

INTRODUCTION: The results from different Cochrane studies justify considerable professional equipoise concerning different treatment options for tinnitus. In case of professional equipoise, Shared Decision Making (SDM) is an indispensable tool for guiding patients to the intervention that best fits their needs. To improve SDM we developed a method to assess the accuracy and utility of decisions made by tinnitus patients when freely choosing between different treatment options during their patient journey. The different treatment options were audiological care and psychosocial counseling. METHODS: We developed a statistical model by combining Signal Detection Theory (SDT) with the Health Belief Model (HBM). HBM states that perceived severity of an illness is strongly related to sick-role behavior. As proxies for perceived severity, we selected hearing loss and Tinnitus Handicap Inventory (THI) score at baseline. Next, we used these proxies as predictors in linear regression models based on SDT to determine the likelihood ratio of true positive decisions (choosing a treatment option and experiencing an improvement of more than 7 points in THI-score) and false positive decisions (choosing a treatment option and experiencing an improvement of less than 7 points in THI-score) for audiological care and psychosocial counseling, respectively. Data was gathered in a prospective cohort of 145 adults referred for tinnitus care to an outpatient audiology clinic in the Netherlands. The participants were asked to decide freely on uptake of audiological care (provision of hearing aids with or without a sound generator) and uptake of psychosocial counseling. Logistic regression with Bayesian inference was used to determine the cumulative distribution functions and the probability density functions of true positive decisions and false positive decisions as function of hearing loss and baseline THI-score for both treatment options, respectively. With the cumulative distribution functions, we determined the accuracy of the decisions. With the probability density functions we calculated the likelihood ratios of true positive decisions versus false positive decisions as function of hearing loss and baseline THI-score. These likelihood ratio functions allow assessment of the utility of the decisions by relating a decision criterion to perceived benefits and costs. RESULTS: Baseline THI-score drives decisions about psychosocial counseling and hearing loss drives decisions about audiological care. Decisions about psychosocial counseling are more accurate than decisions about audiological care. Both decisions have a low accuracy (0.255 for audiological care and  - 0.429 for psychosocial counseling), however. For decisions about audiological care the unbiased decision criterion is 37 dB(HL), meaning that a lenient decision criterion (likelihood ratio  1) by patients with a hearing loss exceeding 37 dB. For psychosocial counseling uptake the decision criterion is always strict, regardless of baseline THI-score. The distributions of the populations, that do and do not experience a clinically important change in THI-score, have unequal variances for psychosocial counseling, while they have almost equal variances for audiological care. DISCUSSION: Combining SDT and HBM can help assess accuracy and utility of patient decisions and thus may provide valuable information that can help to improve SDM by combining patient related outcome measures, decision drivers, and perceived benefits and costs of a treatment

Short-Latency Evoked Potentials of the Human Auditory System

Auditory Brainstem Responses (ABR) are short-latency electric potentials from the auditory nervous system that can be evoked by presenting transient acoustic stimuli to the ear. Sources of the ABR are the auditory nerve and brainstem auditory nuclei. Clinical application of ABRs includes identification of the site of lesion in retrocochlear hearing loss, establishing functional integrity of the auditory nerve, and objective audiometry. Recording of ABR requires a measurement setup with a high-quality amplifier with adequate filtering and low skin-electrode impedance to reduce non-physiological interference. Furthermore, signal averaging and artifact rejection are essential tools for obtaining a good signal-to-noise ratio. Comparing latencies for different peaks at different stimulus intensities allows the determination of hearing threshold, location of the site of lesion, and establishment of neural integrity. Audiological assessment of infants who are referred after failing hearing screening relies on accurate estimation of hearing thresholds. Frequency-specific ABR using tone-burst stimuli is a clinically feasible method for this. Appropriate correction factors should be applied to estimate the hearing threshold from the ABR threshold. Whenever possible, obtained thresholds should be confirmed with behavioral testing. The Binaural Interaction Component of the ABR provides important information regarding binaural processing in the brainstem

Combining the unequal variance signal detection model with the health belief model to optimize shared decision making in tinnitus patients: part 2—patient profiling

IntroductionTinnitus affects approximately 14% of the population. Its symptomatology is versatile, ranging from mild annoyance to anxiety and depression. Current multidisciplinary treatments (psychological, audiological, and combinations) focus on impact reduction and acceptance. Shared decision making (SDM) promotes patients and health care professionals making treatment choices together based on the best available evidence. In the case of professional equipoise (no clear clinical evidence for superiority of a treatment), knowledge about individual factors influencing the outcome of patient decisions can be of utmost importance in informing the SDM process.MethodsA statistical model that was developed in previous work to analyze tinnitus patient decisions, was extended to analyze how patient characteristics on sex, age, and laterality of tinnitus affect the accuracy and utility of decisions concerning audiological care and cognitive behavioral therapy (CBT) based psychosocial counseling. For each group, we calculated Receiver-Operator-Characteristic curves and likelihood ratio curves as function of hearing loss and pre-treatment tinnitus impact to assess accuracy and utility of decisions for audiological care and CBT-based counseling, respectively.ResultsThe largest effect was found for sex differences. The results indicated that males used a strict decision criterion when deciding about psychosocial counseling, while females used a strict decision criterion for decisions about audiological care. The likelihood ratios of a successful treatment versus unsuccessful treatment are smaller than 1 for psychosocial counseling for females and for audiological care for males. The likelihood ratios of success are approximately 2 and almost 7 for audiological care for females and psychosocial counseling for males, respectively. For age differences, older participants adopted a more lenient decision criterion for audiological care across most of the hearing loss range, while younger participants adopt a stricter decision criterion up to hearing losses of approximately 75 dB(HL). For psychosocial counseling, older participants adopted an unbiased criterion and younger participants a strict decision criterion. For the younger group, psychological counseling seems more likely to be successful compared to the older group. When considering laterality, for audiological care the group with unilateral tinnitus adopted a strict decision criterion for the whole range of hearing loss, while the group with bilateral tinnitus adopted a strict decision criterion for hearing losses above approximately 70 dB(HL). For decisions about psychosocial counseling, the unilateral tinnitus group adopt a strict decision criterion for baseline THI-scores between approximately 25 and 90 points. The bilateral tinnitus group adopted an unbiased to strict decision criterion for psychosocial counseling for the entire baseline THI-score range.DiscussionThese findings underscore the importance of personalized treatment approaches based on specific patient characteristics and the need for further research to test and improve these findings. Especially males may be more strongly advised to take up psychosocial counseling and females may be more strongly advised to take up audiological care. For age and laterality, the results are more diffuse

A genome-wide association study of a rage-related misophonia symptom and the genetic link with audiological traits, psychiatric disorders, and personality

Introduction: People with misophonia experience strong negative emotional responses to sounds and associated stimuli—mostly human produced—to an extent that it may cause impairment in social functioning. The exact nature of the disorder remains a matter of ongoing research and debate. Here, we investigated the genetic etiology of misophonia to understand contributing genetic factors and shed light on individual differences in characteristics that are related to the disorder. Methods: For misophonia, we used an unpublished genome-wide association study (GWAS) from genetic service provider 23andMe, Inc., on a self-report item probing a single common misophonic symptom: the occurrence of rage when others produce eating sounds. First, we used gene-based and functional annotation analyses to explore neurobiological determinants of the rage-related misophonia symptom. Next, we calculated genetic correlations (r G) of this rage-related misophonia symptom GWAS with a wide range of traits and disorders from audiology (tinnitus, hearing performance, and hearing trauma), psychiatry, neurology, and personality traits. Results: The rage-related misophonia symptom was significantly correlated with tinnitus, major depression disorder (MDD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD; 0.12 < r G < 0.22). Stronger genetic correlations (0.21 < r G < 0.42) were observed for two clusters of personality traits: a guilt/neuroticism and an irritability/sensitivity cluster. Our results showed no genetic correlation with attention deficit and hyperactivity disorder, obsessive-compulsive disorder, and psychotic disorders. A negative correlation with autism spectrum disorder (ASD) was found, which may be surprising given the previously reported comorbidities and the sensory sensitivity reported in ASD. Clustering algorithms showed that rage-related misophonia consistently clustered with MDD, generalized anxiety, PTSD, and related personality traits. Discussion: We conclude that—based on the genetics of a common misophonia symptom—misophonia most strongly clusters with psychiatric disorders and a personality profile consistent with anxiety and PTSD

Protests: Legal framework and realities

De afgelopen jaren zijn demonstraties en demonstratierecht in toenemende mate onderwerp van maatschappelijke discussie. Nieuwsmedia en onderzoekplatformen berichten erover en ook in de politiek is de discussie levendig. Discussies gaan niet zelden over beperkende maatregelen of repressief optreden door overheid en politie, en daarmee tegen het demonstratierecht in. Tegelijkertijd zijn de meningen en de belangen uiteenlopend; in berichtgeving over overlast of geweld rondom demonstraties worden ook negatieve beelden geschetst over demonstraties, en wordt opgeroepen tot strakkere handhaving. Met dit themanummer van Justitiële verkenningen willen we een inhoudelijke en onderbouwde bijdrage leveren aan deze discussie door het onderwerp ‘demonstratie(recht)’ van verschillende kanten te belichten, met bijdragen vanuit juridisch, historisch, sociologisch en antropologisch perspectief. Vanuit de diverse wetenschappelijke achtergronden komt een aantal typische aspecten van demonstraties en demonstratierecht meerdere keren aan bod. Wat is toegestaan bij demonstraties, hoever mogen demonstranten gaan? Wanneer mag het openbaar bestuur grenzen stellen, en wat is de rol van de politie? Wat maakt dat burgers gaan demonstreren, en wanneer is een demonstratie effectief? In hoeverre veranderen demonstraties door maatschappelijke ontwikkelingen, en wat is de rol van sociale media? INHOUD Juridische spelregels rond de demonstratievrijheid Een tweesnijdend zwaard: de kansen en risico’s van sociale media voor burgerlijk ongehoorzaam klimaatactivisme Onvrede ontleed: demonstraties en geweldloos verzet in repressieve regimes Faciliteren én handhaven: politie-ervaringen en de rol van interacties en beeldvorming bij demonstraties Ruimte voor protest. Wat we kunnen leren van historische onderhandelingsprocessen over demonstraties op lokaal niveau Waarom het zo lastig is om protest – en het verloop daarvan –te voorspellenJustitiële verkenningen (Judicial explorations) is published four times a year by the Research and Data Centre of the Dutch Ministry of Justice and Security in cooperation with Boom juridisch. Each issue focuses on a central theme related to judicial policy. The section Summaries contains abstracts of the internationally most relevant articles of each issue. The central theme of this issue (no. 2, 2025) is Protests: Legal framework and realitie

Cisplatin Ototoxicity in Children

Cisplatin is a highly effective chemotherapy medicine used in the treatment of many childhood cancers. Like all medications, cisplatin has many side effects and as always the treatment of cancer in children is a balance between the risks of the medications used and their potential benefits. While many side effects of cisplatin chemotherapy are reversible, one major side effect is permanent and irreversible hearing loss (ototoxicity) in both ears which may worsen with time. The severity of cisplatin-related ototoxicity is associated with age and the cumulative dose received: the younger the child and the higher the total dose, the more severe the hearing loss may be. The spectrum of hearing loss varies from mild to moderate high tone hearing loss, to profound loss across the hearing range and permanent deafness. In addition to hearing loss, some children, especially adolescents, also experience tinnitus and vertigo. Cisplatin ototoxicity is one of most important of the many long-term effects experienced by children who are cured of their cancer. The burden of this toxicity may be compounded by other long-term health issues that emerge with time. This chapter will focus on cisplatin-induced hearing loss, its mechanisms, its health impact on the young person and ways to mitigate or reduce the severity of ototoxicity. This chapter has been written by a multi-disciplinary team including paediatric oncologists, audiologists, a psychologist, a health scientist and a parent of a child growing up with high frequency hearing loss

A study on prevalence and determinants of ototoxicity during treatment of childhood cancer (SOUND): protocol for a prospective study

Background: Some children with central nervous system (CNS) and solid tumors are at risk to develop ototoxicity during treatment. Up to now, several risk factors have been identified that may contribute to ototoxicity, such as platinum derivates, cranial irradiation, and brain surgery. Comedication, like antibiotics and diuretics, is known to enhance ototoxicity, but their independent influence has not been investigated in childhood cancer patients. Recommendations for hearing loss screening are missing or vary highly across treatment protocols. Additionally, adherence to existing screening guidelines is not always optimal. Currently, knowledge is lacking on the prevalence of ototoxicity. Objective: The aim of the Study on Prevalence and Determinants of Ototoxicity During Treatment of Childhood Cancer (SOUND) is to determine the feasibility of audiological testing and to determine the prevalence and determinants of ototoxicity during treatment for childhood cancer in a national cohort of patients with solid and CNS tumors.Methods: The SOUND study is a prospective cohort study in the national childhood cancer center in the Netherlands. The study aims to include all children aged 0 to 19 years with a newly diagnosed CNS or solid tumor. Part of these patients will get audiological examination as part of their standard of care (stratum 1). Patients in which audiological examination is not the standard of care will be invited for inclusion in stratum 2. Age-dependent audiological assessments will be pursued before the start of treatment and within 3 months after the end of treatment. Apart from hearing loss, we will investigate the feasibility to screen patients for tinnitus and vertigo prevalence after cancer treatment. This study will also determine the independent contribution of antibiotics and diuretics on ototoxicity. Results: This study was approved by the Medical Research Ethics Committee Utrecht (Identifier 20-417/M). Currently, we are in the process of recruitment for this study. Conclusions: The SOUND study will raise awareness about the presence of ototoxicity during the treatment of children with CNS or solid tumors. It will give insight into the prevalence and independent clinical and cotreatment-related determinants of ototoxicity. This is important for the identification of future high-risk patients. Thereby, the study will provide a basis for the selection of patients who will benefit from innovative otoprotective intervention trials during childhood cancer treatment that are currently being prepared.Analysis and Stochastic

An In Vitro Pilot Study Comparing the Novel HemoClear Gravity-Driven Microfiltration Cell Salvage System with the Conventional Centrifugal XTRA (TM) Autotransfusion Device

Background: In 2013, the World Health Organization reported a shortage of 17 million red blood cell units, a number that remains growing. Acts to relieve this shortage have primarily focused on allogeneic blood collection. Nevertheless, autologous transfusion can partially alleviate the current pressure and dependence on blood banking systems. To achieve this, current gold standard autotransfusion devices should be complemented with widely available, cost-efficient, and time-efficient devices. The novel HemoClear cell salvage device (HemoClear BV, Zwolle, Netherlands), a gravity-driven microfilter, potentially is widely employable. We evaluated its performance in the cardiac postoperative setting compared to the centrifugal XTRA™ autotransfusion device. Methods: In a split-unit study (n = 18), shed blood collected 18 hours after cardiothoracic surgery was divided into two equal volumes. One-half was processed by the XTRA™ device and the other with the HemoClear blood separation system. In this paired set-up, equal washing volumes were used for both methods. Washing effectivity and cellular recovery were determined by measuring of complete blood count, free hemoglobin, complement C3, complement C4, and D-dimer in both concentrate as filtrate. Also, processing times and volumes were evaluated. Results: The HemoClear and XTRA™ devices showed equal effectiveness in concentrating erythrocytes and leucocytes. Both methods reduced complement C3, complement C4, and D-dimer by ≥90%. The centrifugal device reduced solutes more significantly by up to 99%. Free hemoglobin load was reduced to 12.9% and 15.5% by the XTRA™ and HemoClear, respectively. Conclusion: The HemoClear device effectively produced washed concentrated red blood cells comparably to the conventional centrifugal XTRA™ autotransfusion device. Although the centrifugal XTRA™ device achieved a significantly higher reduction in contaminants, the HemoClear device achieved acceptable blood quality and seems promising in settings where gold standard cell savers are unaffordable or unpractical

Development of the Musi-CI Training, A Musical Listening Training for Cochlear Implant Users: A Participatory Action Research Approach

A cochlear implant (CI) is a prosthesis that allows people with severe to profound hearing loss to understand speech in quiet settings. However, listening to music presents a challenge to most CI users; they often do not enjoy music or avoid it altogether. The Musi-CI training course was developed for CI users with the goal of reducing music aversion and improving music enjoyment. A consortium was established consisting of a professional musician with CI, CI rehabilitation professionals and researchers. Participatory action research (PAR) was applied to develop and evaluate the training experiences, collaborating with 37 CI users during three cycles of eight training sessions, each held over a period of 3 months. Input and feedback were collected after each training session using questionnaires, observations and focus group interviews. Almost all participants (86%) completed the training. After completing the training a large majority of participants reported increased music appreciation, increased social participation in musical settings and a positive impact on general auditory perception. The resulting Musi-CI training programme focuses on music listening skills, self-efficacy, and self-motivation. It consists of exercises intended to strengthen attention and working memory, to improve beat and rhythm perception (with online rhythm exercises) and exercises to distinguish timbre of instruments and emotion in music. A Melody Game was developed to improve pitch and melodic contour discrimination