Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial

BACKGROUND According to the Word Health Organization, patients who can benefit from palliative care should be identified earlier to enable proactive palliative care. Up to now, this is not common practice and has hardly been addressed in scientific literature. Still, palliative care is limited to the terminal phase and restricted to patients with cancer. Therefore, we trained general practitioners (GPs) in identifying palliative patients in an earlier phase of their disease trajectory and in delivering structured proactive palliative care. The aim of our study is to determine if this training, in combination with consulting an expert in palliative care regarding each palliative patient's tailored care plan, can improve different aspects of the quality of the remaining life of patients with severe chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure and cancer. METHODS/DESIGN A two-armed randomized controlled trial was performed. As outcome variables we studied: place of death, number of hospital admissions and number of GP out of hours contacts. DISCUSSION We expect that this study will increase the number of identified palliative care patients and improve different aspects of quality of palliative care. This is of importance to improve palliative care for patients with COPD, CHF and cancer and their informal caregivers, and to empower the GP. The study protocol is described and possible strengths and weaknesses and possible consequences have been outlined. TRIAL REGISTRATION The Netherlands National Trial Register: NTR2815

Over de vroeg beginnende gasvorming in kaas

The early production of gas in cheese, called 'blowing' was caused chiefly by some coli-aerogenes bacteria of the aerogenes-cloacae type and intermediate types. These bacteria produced gas in a combined fermentation-curdling test both on milk and on cheese; they were called blowing-positive strains.A second group of coli-aerogenes bacteria, although forming acid and gas from lactose in a synthetic lactose medium, did not produce gas in the combined fermentation-curdling test. This was apparently due to the presence of citric acid in the combined test since this acid prevented blowing-negative coliaerogenes strains producing gas from lactose; the citric acid was reduced to succinic acid. As a result these blowing-negative types decomposed the sugar present in the medium without forming gas. Excess of citric acid, however, may be fermented with production of gas. Citric acid always increased gas production by blowing-positive strains through its fermentation. Blowing caused by blowing-positive strains decreased when negative strains were also present.It was found that KN0 3 , KNO 2 , and KClO 3 , prevented gas production from lactose by blowing-positive strains. These compounds seemed to be reduced, thus inhibiting gas production from lactose, while intermediate products occurred which prevented the development of the coli-aerogenes bacteria. KClO 3 appeared to be the most efficient inhibitor. Under practical conditions addition of 1 g per 100 litres milk may be sufficient. Lactic acid fermentation was not influenced by adding this amount of KClO 3

Quasi-Optical Beamforming Network for Millimeter-Wave Electronically Scanned Array Antennas with 1-Bit Phase Resolution

State-of-the-art design solutions for electronically scanned array antennas are mostly limited to microwave to low mm-wave frequency bands, while the demand for new designs at higher frequencies (i.e. frequencies beyond 100 GHz) is rapidly growing. We attempt to fill in this knowledge gap by presenting a new linear array antenna architecture as a building block of 2D arrays that can enable efficient beam steering and a simplified array design. This concept is based on the combination of a low-loss quasi-optical (QO) feed, providing predefined antenna port excitation, with 1-bit phase shifters which are co-integrated with the array antenna elements. In this study, we formulate the array design problem as minimization of the sidelobe level (SLL) through an optimum quasi-randomization of phase errors. An analytical expression for the optimum focal ratio of the QO feed has been derived to establish the relationships between the key design parameters. These results are validated through numerical simulations revealing that the optimum focal ratio leads to the minimum SLL

Millimeter-Wave Quasi-Optical Feeds for Linear Array Antennas in Gap Waveguide Technology

A realization of the quasi-optical (QO) feed concept for linear millimeter-wave (sub-)array antennas is demonstrated in gap waveguide technology. The proposed feed architecture employs an input transition from a ridge gap waveguide (RGW) to a groove gap waveguide (GGW), a radial (H-plane sectoral) GGW section, and a transition to an output RGW array. A design decomposition approach is presented to reduce simulation complexity. Several 20-element QO feed implementations are investigated at W-band demonstrating a 20% relative bandwidth (85-105 GHz), 0.5 dB insertion loss, and a capability of an amplitude taper control within the 10-20 dB range

Invloed van vocht in het asfaltproductieproces - wat zijn de gevolgen en hoe kunnen deze gevolgen beperkt worden

Bij de productie van asfalt bij verschillende asfaltcentrales liggen de bouwstoffen in de open lucht. Deze bouwstoffen bevatten vocht uit o.a. de bron. De gevolgen van dit vocht zijn vermoedelijk een moeilijker te controleren productieproces en hogere stookkosten. In deze paper worden de exacte gevolgen bekeken en gezocht naar reductieopties. Om de gevolgen in kaart te brengen zijn er interviews afgenomen en metingen verricht. Er is gekozen voor interviews, omdat de literatuur niet afdoende was om beeld te scheppen van het probleem. De metingen zijn verricht om een onafhankelijk beeld te creëren en deze resultaten te vergelijken met die van de experts. De metingen zijn volgens NEN-EN 12697-27 normen uitgevoerd. Uit de metingen en interviews is gebleken dat het vocht afneemt, naarmate de diameter van de bouwstof toeneemt. Zandfracties en gerecycled asfalt(PR) bevatten het meeste vocht, namelijk 2,6% en meer. De metingen bevestigen de meeste gegevens die uit de interviews naar voren zijn gekomen. De stookkosten zijn aanzienlijk hoger dan nodig is door de hoeveelheid vocht die aanwezig is in het materiaal als er wordt gekeken naar de top 20 meest geproduceerde mengsels. Het weer blijkt geen invloed te hebben op PR, maar wel op zand en steen op basis van vochtmetingen uit historische data. Dit onderzoek heeft bevestigd dat vocht voornamelijk een nadelig effect heeft op het asfaltproductieproces. Het mengen van asfalt wordt bemoeilijkt en er zijn hogere productiekosten. Vocht zorgt daarnaast voor een kortere levensduur van het asfalt. Om de negatieve effecten van vocht te reduceren wordt aanbevolen om een PR-overkapping te bouwen om het percentage van vocht in het PR te laten dalen. Om het proces beter te kunnen beheersen wordt er geadviseerd om vochtmeters te plaatsen. Voor verder onderzoek kan de nadruk gelegd worden op de winning van PR, de afwatering die op het terrein plaats vindt en het terug winnen van energie

Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial

Contains fulltext : 96843.pdf (publisher's version ) (Open Access)BACKGROUND: According to the Word Health Organization, patients who can benefit from palliative care should be identified earlier to enable proactive palliative care. Up to now, this is not common practice and has hardly been addressed in scientific literature. Still, palliative care is limited to the terminal phase and restricted to patients with cancer. Therefore, we trained general practitioners (GPs) in identifying palliative patients in an earlier phase of their disease trajectory and in delivering structured proactive palliative care. The aim of our study is to determine if this training, in combination with consulting an expert in palliative care regarding each palliative patient's tailored care plan, can improve different aspects of the quality of the remaining life of patients with severe chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure and cancer. METHODS/DESIGN: A two-armed randomized controlled trial was performed. As outcome variables we studied: place of death, number of hospital admissions and number of GP out of hours contacts. DISCUSSION: We expect that this study will increase the number of identified palliative care patients and improve different aspects of quality of palliative care. This is of importance to improve palliative care for patients with COPD, CHF and cancer and their informal caregivers, and to empower the GP. The study protocol is described and possible strengths and weaknesses and possible consequences have been outlined. TRIAL REGISTRATION: The Netherlands National Trial Register: NTR2815

Genome-wide association study for tumour stage, grade, size, and age at diagnosis of non-muscle-invasive bladder cancer

BACKGROUND: Non-muscle-invasive bladder cancer (NMIBC) causes a considerable health burden due to the high recurrence and progression rates. Past studies have identified multiple candidate loci associated with NMIBC prognosis, albeit lacking validation. Moreover, scarce reports exist on genetic susceptibility to independent prognostic predictors of NMIBC, such as stage or grade. OBJECTIVE: To investigate genetic associations with NMIBC tumour and patient characteristics at the time of diagnosis. DESIGN, SETTING, AND PARTICIPANTS: A sample of 653 NMIBC cases comes from the Bladder Cancer Prognosis Programme. Replication of the significant findings was conducted in the Nijmegen Bladder Cancer Study cohort (N=1470). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A genome-wide association study (GWAS) was carried out for outcomes of tumour size (as a continuous variable in centimetres), stage (Tis and T1 vs Ta), grade (G3 vs G2 and G1), and age (as continuous [years] and dichotomous [70.2 yr as a cut-off] variables). RESULTS AND LIMITATIONS: Significant (p<5E-08) associations (N=61) with tumour size, stage, grade, and age were identified in the GWAS discovery stage. None of the variants were independently significantly associated in the replication cohort. A meta-analysis of both cohorts suggests that rs180940944 (13q13.3 locus, NBEA) was associated with tumour size as a continuous variable (ss=0.9cm, p=2.92E-09). However, other single nucleotide polymorphisms in this region did not show evidence of association in the meta-analysis. CONCLUSIONS: Our study suggests that rs180940944 (NBEA) is associated with an increased NMIBC tumour size at the time of diagnosis. Given study limitations, further replication is essential to validate the finding. PATIENT SUMMARY: The current study reports on a genome-wide association study on non-muscle-invasive bladder cancer tumour and patient characteristics. We suggest that NBEA gene might be associated with increased tumour size at the time of diagnosis. The result must be replicated to establish validity