Dissociated vertical deviation and eye torsion: Relation to disparity-induced vertical vergence

We studied the relation between vertical eye movements and binocular torsion in five subjects with dissociated vertical deviation (DVD). During trials, subject viewed a well illuminated Snellen letter chart, with both eyes uncovered during 4 seconds. Subsequently, DVD was induced by covering one eye during 4 seconds. Finally, both eyes were uncovered during 4 seconds. Several trials were recorded for each subject and covered eye. Eye movements were measured with scleral coils. We found that in all subjects, the vertical divergence followed an exponential course with a time constant of 0.67 ± 0.14 seconds on average. In three of the five subjects this vertical divergence was associated with binocular torsion (cycloversion), partly, in the form of a cycloversional nystagmus. The time course of the vertical divergence as well as the direction and nystagmic nature of the cycloversion was similar to the behaviour that was previously observed in disparity induced vertical vergence in normal subjects. In two of the subjects, the torsion that was associated with the vertical divergence was monocular. Our results indicate that DVD and disparity induced vertical vergence share the same characteristics. In addition, they demonstrate that extorsion associated with the elevation in DVD possibly but not necessarily points at a dissociated torsional deviation

Ultra-energiezuinige kassystemen met Supertransparante Micro-V Gestructureerde materialen: Rapportage in het kader van het EOS-LT programma van Agentschap NL (Openbare versie)

Doel van het in dit rapport beschreven onderzoek is het gebruiken van micro- en nanostructuren uit de PV-industrie om te komen tot een diffuus kasdekmateriaal met een hoge hemisferische transmissie. Hierbij wordt gebruik gemaakt van de kennis die in het verleden is opgedaan in het ontwikkelen van het zigzag kasdekmateriaal. Met de ontwikkelde kennis kan energiebesparing gerealiseerd worden door het toepassen van de structuren op dubbel glas, waardoor materiaal gemaakt kan worden met een hoge hemisferische transmissie, diffuse eigenschappen en een hoge isolatiewaarde. Randvoorwaarde hierin is dat het ontwikkelde kasdekmateriaal toepasbaar is in een glastuinbouwmilieu. Dit betekent dat het materiaal niet mag verouderen, condensatie de transmissie niet mag verminderen en extra vervuiling niet mag optreden. Hierbij wordt de Nederlandse situatie als uitgangspunt genomen, maar interessante structuren voor andere klimaten zullen niet worden uitgesloten

High prevalence of non-accidental trauma among deceased children presenting at Level I trauma centers in the Netherlands

PURPOSE: Between 0.1—3% of injured children who present at a hospital emergency department ultimately die as a result of their injuries. These events are typically reported as unnatural causes of death and may result from either accidental or non-accidental trauma (NAT). Examples of the latter include trauma that is inflicted directly or resulting from neglect. Although consultation with a forensic physician is mandatory for all deceased children, the prevalence of fatal inflicted trauma or neglect among children is currently unclear. METHODS: This is a retrospective study that included children (0–18 years) who presented and died at one of the 11 Level I trauma centers in the Netherlands between January 1, 2014, and January 1, 2019. Outcomes were classified based on the conclusions of the Child Abuse and Neglect team or those of forensic pathologists and/or the court in cases referred for legally mandated autopsies. Cases in which conclusions were unavailable and there was no clear accidental cause of death were reviewed by an expert panel. RESULTS: The study included 175 cases of childhood death. Seventeen (9.7%) of these children died due to inflicted trauma (9.7%), 18 (10.3%) due to neglect, and 140 (80%) due to accidents. Preschool children (< 5 years old) were significantly more likely to present with injuries due to inflicted trauma and neglect compared to older children (44% versus 6%, p < 0.001, odds ratio [OR] 5.80, 95% confidence interval [CI] 2.66–12.65). Drowning accounted for 14 of the 18 (78%) pediatric deaths due to neglect, representing 8% of the total cases. Postmortem radiological studies and autopsies were performed on 37 (21%) of all cases of childhood death. CONCLUSION: One of every five pediatric deaths in our nationwide Level I trauma center study was attributed to NAT; 44% of these deaths were the result of trauma experienced by preschool-aged children. A remarkable number of fatal drownings were due to neglect. Postmortem radiological studies and autopsies were performed in only one-fifth of all deceased children. The limited use of postmortem investigations may have resulted in missed cases of NAT, which will result in an overall underestimation of fatal NAT experienced by children. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12024-021-00416-7

National laboratory-based surveillance system for antimicrobial resistance: a successful tool to support the control of antimicrobial resistance in the Netherlands

An important cornerstone in the control of antimicrobial resistance (AMR) is a well-designed quantitative system for the surveillance of spread and temporal trends in AMR. Since 2008, the Dutch national AMR surveillance system, based on routine data from medical microbiological laboratories (MMLs), has developed into a successful tool to support the control of AMR in the Netherlands. It provides background information for policy making in public health and healthcare services, supports development of empirical antibiotic therapy guidelines and facilitates in-depth research. In addition, participation of the MMLs in the national AMR surveillance network has contributed to sharing of knowledge and quality improvement. A future improvement will be the implementation of a new semantic standard together with standardised data transfer, which will reduce errors in data handling and enable a more real-time surveillance. Furthermore, the

Increase in treatment of retinopathy of prematurity in the Netherlands from 2010 to 2017

Purpose: Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods. Methods: Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1-1-2010 to 31-3-2013 and P2: 1-4-2013 to 31-12-2016. Treatment characteristics, adherence to early treatment for ROP (ETROP) criteria, outco

SUGAR-DIP trial: Oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial

Introduction In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. Methods The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals