Raman lidar profiling of tropospheric water vapor

Obtaining vertical profiles of tropospheric water vapor provides critically important information towards understanding short and long term global climate change. Ground-based Raman lidar technique is a powerful tool to precisely evaluating Water vapor Mixing Ratio (WVMR) in the troposphere. In this presentation, an overview of the design and basic components of a Raman water vapor lidar setup employing the third harmonic output (at 355 nm) of a high-powered laser with a telescope and three detection channels will be presented. Also, detailed discussion of the best method to calibrate and evaluate the performance of a typical water vapor Raman lidar will be shown and compared with most common calibration methods. By manipulating the inelastic backscattering lidar signals from the Raman nitrogen channel (386.7 nm) and Raman water vapor channel (407.5 nm), vertical profiles of water vapor mixing ratio (WVMR) will be deduced, calibrated, and compared against WVMR profiles obtained from coincident and collocated radiosonde profiles. This presented methodology will be shown to effectively yield high temporal and spatial resolution measurements of WVMR, with efficient dual detector capability both in the near-and-far fields

Gender-stratified analyses of symptoms associated with acute coronary syndrome in telephone triage: A cross-sectional study

OBJECTIVES: To identify clinical variables that are associated with the diagnosis acute coronary syndrome (ACS) in women and men with chest discomfort who contact out-of-hours primary care (OHS-PC) by telephone, and to explore whether there are indications whether these variables differ among women and men. DESIGN: Cross-sectional study in which we compared patient and call characteristics of triage call recordings between women with and without ACS, and men with and without ACS. SETTING: Nine OHS-PC in the Netherlands. PARTICIPANTS: 993 women and 802 men who called OHS-PC for acute chest discomfort (pain, pressure, tightness or discomfort) between 2014 and 2016. PRIMARY OUTCOME MEASURE: Diagnosis of ACS retrieved from the patient's medical record in general practice, including hospital specialists' discharge letters. RESULTS: Among 1795 patients (mean age 58.8 (SD 19.5) years, 55.3% women), 15.0% of men and 8.6% of women had an ACS. In both sexes, retrosternal chest pain was associated with ACS (women with ACS vs without 62.3% vs 40.3%, p=0.002; men with ACS vs without 52.5% vs 39.7%, p=0.032; gender interaction, p=0.323), as was pressing/heavy/tightening pain (women 78.6% vs 61.5%, p=0.011; men 82.1% vs 57.4%, p=<0.001; gender interaction, p=0.368) and radiation to the arm (women 75.6% vs 45.9%, p<0.001; men 56.0% vs 34.8%, p<0.001; gender interaction, p=0.339). Results indicate that only in women were severe pain (65.4% vs 38.1%, p=0.006; gender interaction p=0.007) and radiation to jaw (50.0% vs 22.9%, p=0.007; gender interaction p=0.015) associated with ACS.Ambulances were dispatched equally in women (72.9%) and men with ACS (70.0%). CONCLUSION: Our results indicate there were more similarities than differences in symptoms associated with the diagnosis ACS for women and men. Important exceptions were pain severity and radiation of pain in women. Whether these differences have an impact on predicting ACS needs to be further investigated with multivariable analyses. TRIAL REGISTRATION NUMBER: NTR7331

Common infections and antibiotic prescribing during the first year of the covid-19 pandemic: A primary care-based observational cohort study

Presentation and antibiotic prescribing for common infectious disease episodes decreased substantially during the first COVID-19 pandemic wave in Dutch general practice. We set out to determine the course of these variables during the first pandemic year. We conducted a retrospective observational cohort study using routine health care data from the Julius General Practitioners’ Network. All patients registered in the pre-pandemic year (n = 425,129) and/or during the first pandemic year (n = 432,122) were included. Relative risks for the number of infectious disease episodes (respiratory tract/ear, urinary tract, gastrointestinal, and skin), in total and those treated with antibiotics, and proportions of episodes treated with antibiotics (prescription rates) were calculated. Compared to the pre-pandemic year, primary care presentation for common infections remained lower during the full first pandemic year (RR, 0.77; CI, 0.76–0.78), mainly attributed to a sustained decline in respiratory tract/ear and gastrointestinal infection episodes. Presentation for urinary tract and skin infection episodes declined during the first wave, but returned to pre-pandemic levels during the second and start of the third wave. Antibiotic prescription rates were lower during the full first pandemic year (24%) as compared to the pre-pandemic year (28%), mainly attributed to a 10% lower prescription rate for respiratory tract/ear infections; the latter was not accompanied by an increase in complications. The decline in primary care presentation for common infections during the full first COVID-19 pandemic year, together with lower prescription rates for respiratory tract/ear infections, resulted in a substantial reduction in antibiotic prescribing in Dutch primary care

A Strong Decline in the Incidence of Childhood Otitis Media During the COVID-19 Pandemic in the Netherlands

Introduction: Recent reports have highlighted the impact of the COVID-19 pandemic on the incidence of infectious disease illnesses and antibiotic use. This study investigates the effect of the pandemic on childhood incidence of otitis media (OM) and associated antibiotic prescribing in a large primary care-based cohort in the Netherlands. Material and Methods: Retrospective observational cohort study using routine health care data from the Julius General Practitioners’ Network (JGPN). All children aged 0-12 registered in 62 practices before the COVID-19 pandemic (1 March 2019 - 29 February 2020) and/or during the pandemic (1 March 2020 - 28 February 2021) were included. Data on acute otitis media (AOM), otitis media with effusion (OME), ear discharge episodes and associated antibiotic prescriptions were extracted. Incidence rates per 1,000 child years (IR), incidence rate ratios (IRR) and incidence rate differences (IRD) were compared between the two study periods. Results: OM episodes declined considerably during the COVID-19 pandemic: IR pre-COVID-19 vs COVID-19 for AOM 73.7 vs 27.1 [IRR 0.37]; for OME 9.6 vs 4.1 [IRR 0.43]; and for ear discharge 12.6 vs 5.8 [IRR 0.46]. The absolute number of AOM episodes in which oral antibiotics were prescribed declined accordingly (IRD pre-COVID-19 vs COVID-19: -22.4 per 1,000 child years), but the proportion of AOM episodes with antibiotic prescription was similar in both periods (47% vs 46%, respectively). Discussion: GP consultation for AOM, OME and ear discharge declined by 63%, 57% and 54% respectively in the Netherlands during the COVID-19 pandemic. Similar antibiotic prescription rates before and during the pandemic indicate that the case-mix presenting to primary care did not considerably change. Our data therefore suggest a true decline as a consequence of infection control measures introduced during the pandemic

Herverdeling van zorgtaken van 2e naar 1e lijn: nu doorpakken

Herverdeling van taken tussen de eerste en tweede lijn vindt al decennialang plaats en was al onderwerp van discussie in de vorige eeuw.1Huisartsen hebben veel taken van de tweede lijn overgenomen, zowel in het voortraject – de diagnostiek van aandoeningen – als in de routinezorg na consultatie door een medisch specialist. Het ontwikkelen van de NHG-standaarden en van transmurale afspraken heeft hier sterk aan bijgedragen. De diabeteszorg is een mooi voorbeeld van de verplaatsing van een groot deel van de zorg naar de eerste lijn. Toch blijken er steeds hobbels die verdergaande substitutie in de weg staan. Dat zijn financiële hobbels, cultuurverschillen tussen de echelons en de structuur van het huidige zorgstelsel. [...

Transferring care from secondary to primary health services:time for action

Herverdeling van taken tussen de eerste en tweede lijn vindt al decennialang plaats en was al onderwerp van discussie in de vorige eeuw.1Huisartsen hebben veel taken van de tweede lijn overgenomen, zowel in het voortraject – de diagnostiek van aandoeningen – als in de routinezorg na consultatie door een medisch specialist. Het ontwikkelen van de NHG-standaarden en van transmurale afspraken heeft hier sterk aan bijgedragen. De diabeteszorg is een mooi voorbeeld van de verplaatsing van een groot deel van de zorg naar de eerste lijn. Toch blijken er steeds hobbels die verdergaande substitutie in de weg staan. Dat zijn financiële hobbels, cultuurverschillen tussen de echelons en de structuur van het huidige zorgstelsel. [...