Toekomstige zorgbehoefte in Nederland; een kwantitatieve verkenning

Political Scienc

Alternative Energy Carriers in Naval Vessels

In order to reduce fossil fuel consumption of the Royal Netherlands Navy (RNLN) by 70% in 2050, the use of alternative fuels on the large naval surface vessels is examined. This paper examines the implications for the design and operational effectiveness of these vessels by performing two case studies of the Zeven Provinci¨en air defence and command frigate (LCF) and the Johan de Witt landing platform dock (LPD). In the case studies an operational analysis, a parametric design study, and an effectiveness assessment are performed on multiple proposed designs. Results showed that it is possible to reduce the fossil fuel consumption of the RNLN by almost 70%. This does affect the design of the vessels, however. It was also concluded that the LPD is more suitable for the application of low-energy-density fuels than the LCF, due to its missions requirements. Both the LPD and the LCF show a significant increase in displacement and fuel cost, but it is possible to reduce effects on the operational effectiveness to a minimum.Ship Design, Production and Operation

Diagnostic performance of the ACR/EULAR 2010 criteria for rheumatoid arthritis and two diagnostic algorithms in an early arthritis clinic (REACH)

Introduction An ACR/EULAR task force released new criteria to classify rheumatoid arthritis at an early stage. This study evaluates the diagnostic performance of these criteria and algorithms by van der Helm and Visser in REACH. Methods Patients with symptoms <= 12 months from REACH were used. Algorithms were tested on discrimination, calibration and diagnostic accuracy of proposed cut-points. Two patient sets were defined to test robustness; undifferentiated arthritis (UA) (n=231) and all patients including those without synovitis (n=513). The outcomes evaluated were methotrexate use and persistent disease at 12 months. Results In UA patients all algorithms had good areas under the curve 0.79, 95% CI 0.73 to 0.83 for the ACR/EULAR criteria, 0.80, 95% CI 0.74 to 0.87 for van der Helm and 0.83, 95% CI 0.77 to 0.88 for Visser. All calibrated well. Sensitivity and specificity were 0.74 and 0.66 for the ACR/EULAR criteria, 0.1 and 1.0 for van der Helm and 0.59 and 0.93 for Visser. Similar results were found in all patients indicating robustness. Conclusion The ACR/EULAR 2010 criteria showed good diagnostic properties in an early arthritis cohort reflecting daily practice, as did the van der Helm and Visser algorithms. All were robust. To promote uniformity and comparability the ACR/EULAR 2010 criteria should be used in future diagnostic studies