Oor die diagnostiese en prognostiese waarde van die vaginaal- uitstryk by steurnisse in swangerskap

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Vaginaaluitstryke in normale en verlengde swangerskap

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Is It Time for a Change? A Cost-Effectiveness Analysis Comparing a Multidisciplinary Integrated Care Model for Residential Homes to Usual Care

OBJECTIVE: The objective of this study was to evaluate the cost-effectiveness of a Multidisciplinary Integrated Care (MIC) model compared to Usual Care (UC) in Dutch residential homes. METHODS: The economic evaluation was conducted from a societal perspective alongside a 6 month, clustered, randomized controlled trial involving 10 Dutch residential homes. Outcome measures included a quality of care weighted sum score, functional health (COOP WONCA) and Quality Adjusted Life-Years (QALY). Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to analyze differences in costs and cost-effectiveness. RESULTS: The quality of care sum score in MIC was significantly higher than in UC. The other primary outcomes showed no significant differences between the MIC and UC. The costs of providing MIC were approximately €225 per patient. Total costs were €2,061 in the MIC group and €1,656 for the UC group (mean difference €405, 95% -13; 826). The probability that the MIC was cost-effective in comparison with UC was 0.95 or more for ceiling ratios larger than €129 regarding patient related quality of care. Cost-effectiveness planes showed that the MIC model was not cost-effective compared to UC for the other outcomes. INTERPRETATION: Clinical effect differences between the groups were small but quality of care was significantly improved in the MIC group. Short term costs for MIC were higher. Future studies should focus on longer term economic and clinical effects. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN11076857

Global sensitivity analysis of model uncertainty in aeroelastic wind turbine models

A framework is presented for performing global sensitivity analysis of model parameters associated with the Blade Element Momentum (BEM) models. Sobol indices based on adaptive sparse polynomial expansions are used as a measure of global sensitivities. The sensitivity analysis workflow is developed using the uncertainty quantification toolbox UQLab that is integrated with TNO's Aero-Module aeroelastic code. Uncertainties in chord, twist, and lift- and drag-coefficients have been parametrized through the use of NURBS curves. Sensitivity studies are performed on the NM80 wind turbine model from the DanAero project, for a case with 19 uncertainties in both model and geometry. The combination of parametrization and sparse adaptive polynomial chaos yields a new efficient framework for global sensitivity analysis of aeroelastic wind turbine models, paving the way to effective model calibration

Comparison of 3D transitional CFD simulations for rotating wind turbine wings with measurements:Paper

Since the investigation of van Ingen et al., attempts were undertaken to search for laminar parts within the boundary layer of wind turbines operating in the lower atmosphere with much higher turbulence levels than seen in wind tunnels or at higher altitudes where airplanes usually fly. Based on the results of the DAN-Aero experiment and the Aerodynamic Glove project, a special work package Boundary Layer Transition was embedded in IAEwind Task 29 MexNext 3rd phase (MN3). Here, we report on the results of the application of various CFD tools to predict transition on the MEXICO blade. In addition, recent results from a comparison of thermographic pictures (aimed at detecting transition) with 3D transitional CFD are included as well. The MEXICO (2006) and NEW MEXICO (2014) wind tunnel experiments on a turbine equipped with three 2.5 m blades have been described extensively in the literature. In addition, during MN3, high-frequency Kulite data from experiments were used to detect traces of transitional effects. Complementary, the following set of codes were applied to cases 1.1 and 1.2 (axial inflow with 10 m/s and 15 m/s respectively) – elsA, CFX, OpenFOAM (with 2 different turbulence/transitional models), Ellipsys, (with 2 different turbulence models and eN transition prediction tool), FLOWer and TAU – to search for detection of laminar parts by means of simulation. Obviously, the flow around a rotating blade is much more complicated than around a simple 2D section. Therefore, results for even integrated quantities like thrust and torque are varying strongly. Nevertheless, visible differences between fully turbulent and transitional set-ups are present. We discuss our findings, especially with respect to turbulence and transition models used

Randomized, double-blind, placebo-controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA-RESPONSE-AHF)

Aims: Inhibition of sodium–glucose co-transporter 2 (SGLT2) reduces the risk of death and heart failure (HF) admissions in patients with chronic HF. However, safety and clinical efficacy of SGLT2 inhibitors in patients with acute decompensated HF are unknown. Methods and results: In this randomized, placebo-controlled, double-blind, parallel group, multicentre pilot study, we randomized 80 acute HF patients with and without diabetes to either empagliflozin 10 mg/day or placebo for 30 days. The primary outcomes were change in visual analogue scale (VAS) dyspnoea score, diuretic response (weight change per 40 mg furosemide), change in N-terminal pro brain natriuretic peptide (NT-proBNP), and length of stay. Secondary outcomes included safety and clinical endpoints. Mean age was 76 years, 33% were female, 47% had de novo HF and median NT-proBNP was 5236 pg/mL. No difference was observed in VAS dyspnoea score, diuretic response, length of stay, or change in NT-proBNP between empagliflozin and placebo. Empagliflozin reduced a combined endpoint of in-hospital worsening HF, rehospitalization for HF or death at 60 days compared with placebo [4 (10%) vs. 13 (33%); P = 0.014]. Urinary output up until day 4 was significantly greater with empagliflozin vs. placebo [difference 3449 (95% confidence interval 578–6321) mL; P < 0.01]. Empagliflozin was safe, well tolerated, and had no adverse effects on blood pressure or renal function. Conclusions: In patients with acute HF, treatment with empagliflozin had no effect on change in VAS dyspnoea, diuretic response, NT-proBNP, and length of hospital stay, but was safe, increased urinary output and reduced a combined endpoint of worsening HF, rehospitalization for HF or death at 60 days

Longitudinal Changes in Circulating Ketone Body Levels in Patients With Acute Heart Failure:A Post Hoc Analysis of the EMPA-Response-AHF Trial

Background: Ketone bodies are endogenous fuels produced by the liver under conditions of metabolic or neurohormonal stress. Circulating ketone bodies are increased in patients with chronic heart failure (HF), yet little is known about the effect of acute HF on ketosis. We tested the hypothesis that ketogenesis is increased in patients with acute decompensated HF. Methods and results: This was a post hoc analysis of 79 patients with acute HF included in the EMPA-RESPONSE-AHF trial, which compared sodium-dependent glucose-cotransporter protein 2 inhibitor treatment with empagliflozin for 30 days with placebo in patients with acute HF [NCT03200860]. Plasma concentrations of ketone bodies acetone, β-hydroxybutyrate, and acetoacetate were measured at baseline and 5 different timepoints. Changes in ketone bodies over time were monitored using repeated measures analysis of variance. In the total cohort, median total ketone body concentration was 251 µmol/L (interquartile range, 178–377 µmol/L) at baseline, which gradually decreased to 202 µmol/L (interquartile range, 156–240 µmol/L) at day 30 (P = .041). Acetone decreased from 60 µmol/L (interquartile range, 34–94 µmol/L) at baseline to 30 µmol/L (interquartile range, 21–42 µmol/L) ( P < .001), whereas β-hydroxybutyrate and acetoacetate remained stable over time. Higher acetone concentrations were correlated with higher N-terminal pro brain natriuretic peptide levels (r = 0.234; P = .039). Circulating ketone bodies did not differ between patients treated with empagliflozin or placebo throughout the study period. A higher acetone concentration at baseline was univariately associated with a greater risk of the composite end point, including in-hospital worsening HF, HF rehospitalizations, and all-cause mortality after 30 days. However, after adjustment for age and sex, acetone did not remain an independent predictor for the combined end point. Conclusions: Circulating ketone body concentrations, and acetone in particular, were significantly higher during an episode of acute decompensated HF compared with after stabilization. Treatment with empagliflozin did not affect ketone body concentrations in patients with acute HF

ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis

ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis.BackgroundIn dialysis patients, only a few follow-up studies have addressed the relationship between the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene and mortality, but the available data are contradictory.MethodsA cohort of 453 consecutive patients starting dialysis between January 1999 and January 2002 and participating in a Dutch multicenter prospective study was examined. Patients who died within 3 months after the start of dialysis were excluded. Patients were followed until date of death or censoring in November 2003.ResultsThe ACE II, ID, and DD genotype frequencies were 24.3% (N = 110), 50.1% (N = 227), and 25.6% (N = 116). Besides a slightly higher number of Caucasians in the DD group, all other patient characteristics of the 3 ACE groups were similar at the start of dialysis. After adjustment for age, comorbidity, and ethnic background, patients with the ID and DD genotype showed an increased hazard ratio (HR) for all-cause mortality of 1.55 (95% CI 1.00-2.42) and 2.30 (95% CI 1.41-3.75), compared to patients with the II genotype. Slightly lower HRs were found for cardiovascular mortality. All groups of primary kidney disease showed a 2- to 3-fold increased adjusted HR for DD.ConclusionThe DD genotype identifies dialysis patients at an increased risk for mortality