An Approach to Analyze the Intermodal Rail Transport Market in Germany

This study aims to provide a complete overview of intermodal rail connections in Germany and identify the market players involved in their operation. The lack of a comprehensive overview is attributed to the difficulty of summarizing empirical data of intermodal rail transport, combined with the many rapid changes in the dynamic open market. The study uses a dataset compiled through online research and interviews with market players. The identified market players include intermodal operators, railway carriers, terminals, and ports

Association of NIPA1 repeat expansions with amyotrophic lateral sclerosis in a large international cohort

NIPA1 (nonimprinted in Prader-Willi/Angelman syndrome 1) mutations are known to cause hereditary spastic paraplegia type 6, a neurodegenerative disease that phenotypically overlaps to some extent with amyotrophic lateral sclerosis (ALS). Previously, a genomewide screen for copy number variants found an association with rare deletions in NIPA1 and ALS, and subsequent genetic analyses revealed that long (or expanded) polyalanine repeats in NIPA1 convey increased ALS susceptibility. We set out to perform a large-scale replication study to further investigate the role of NIPA1 polyalanine expansions with ALS, in which we characterized NIPA1 repeat size in an independent international cohort of 3955 patients with ALS and 2276 unaffected controls and combined our results with previous reports. Meta-analysis on a total of 6245 patients with ALS and 5051 controls showed an overall increased risk of ALS in those with expanded (>8) GCG repeat length (odds ratio = 1.50, p = 3.8×10-5). Together with previous reports, these findings provide evidence for an association of an expanded polyalanine repeat in NIPA1 and ALS

An Approach to Analyze the Intermodal Rail Transport Market in Germany

This study aims to provide a complete overview of intermodal rail connections in Germany and identify the market players involved in their operation. The lack of a comprehensive overview is attributed to the difficulty of summarizing empirical data of intermodal rail transport, combined with the many rapid changes in the dynamic open market. The study uses a dataset compiled through online research and interviews with market players. The identified market players include intermodal operators, railway carriers, terminals, and ports

An Approach to Analyze the Intermodal Rail Transport Market in Germany

This study aims to provide a complete overview of intermodal rail connections in Germany and identify the market players involved in their operation. The lack of a comprehensive overview is attributed to the difficulty of summarizing empirical data of intermodal rail transport, combined with the many rapid changes in the dynamic open market. The study uses a dataset compiled through online research and interviews with market players. The identified market players include intermodal operators, railway carriers, terminals, and ports

Better care for febrile children seen at out-of-hours services

Kool M, Elshout G, Bohnen AM, Koes BW, Berger MY. Better care for febrile children seen at out-of-hours services. Huisarts Wet 2016;59(11):474-7. Parents contact out-of-hours services relatively often because their child has a temperature and mention one or more alarm symptoms. The vast majority of these children have a non-serious infection and do not require further treatment. Children that appear to be seriously ill should be referred to secondary care. The Dutch Association of General Practitioners’ guideline ‘Children with fever’ recommends that children with only one alarm symptom be referred, but the majority of these referrals turn out to be a false alarm. General practitioners are relatively conservative in their referrals and score better in this respect than diagnostic algorithms, so it seems that they are guided by more than the alarm symptoms alone. It is more complex if GPs are uncertain about the seriousness of the illness. They often prescribe an antibiotic to reassure themselves and the parents, but this should be avoided because it gives a false sense of security. It would be better to clearly tell the parents when and where they should contact the service again. If the medical record is complete and unambiguous, the course of the disorder can be reviewed in the follow-up consultation, even if this occurs with a different GP

C-Reactive Protein Level as Diagnostic Marker in Young Febrile Children Presenting in a General Practice Out-of-Hours Service

Background: It is unclear how well a C-reactive protein (CRP) value predicts a serious infection (SI) in young febrile children in general practice. Methods: This prospective cohort study with 1-week follow-up included children, aged 3 months to 6 years, presenting with fever to a general practitioner out-of-hours service. We evaluate whether CRP level has predictive value for diagnosing a child at risk for an SI either at presentation or during follow-up. The index test was CRP 80 mg/L (rule in an SI). The reference standard was referral to a pediatric emergency department or diagnosis of an SI. The main outcome measure was CRP value. Results: CRP level was available for 440 children. To rule out an SI, CRP 80 mg/L increased the probability of having an SI from 11.4% (pretest probability) to 21.2% (posttest probability). In children without a diagnosis of SI at presentation, CRP could not predict an SI during follow-up (CRP >80 mg/L: positive likelihood ratio, 2.1, 95% confidence interval, 1.3-3.5; CRP <= 20 mg/L: negative likelihood ratio, 0.9, 95% confidence interval, 0.7-1.2). Conclusions: In general practice CRP has little clinically relevant value in discriminating febrile children in need of medical care from those who are not

Duration of Fever and Course of Symptoms in Young Febrile Children Presenting with Uncomplicated Illness

Purpose: It is important to advise parents when to consult a doctor when their child has fever. To provide evidence-based, safety-net advice for young febrile children, we studied the risk of complications, the occurrence of alarm symptoms, the duration of fever. Methods: In a 7-day prospective follow-up study, we included 463 consecutive children aged 3 months to 6 years who presented with fever at a general practitioner out-of-hours service. We excluded 43 children with complicated illnesses at presentation. In a structured assessment, the duration of fever before presentation was noted and a physical examination was performed. Parents reported alarming symptoms and rectal temperature in a diary for 1 week. The total duration of fever included its dura Results: During follow-up, 3.2% of the children with uncomplicated illness at presentation developed a complicated illness. The presence of alarming symptoms dropped from 79.3% at day 2 of the fever episode to 36.7% at day 9. The estimated median duration of the total fever episode was 4.0 days (95% confidence interval, 3.6-4.4). Conclusions: In children with uncomplicated illnesses, the daily occurrence of alarming symptoms reported by parents was high. The median duration of fever was 4 days. The predictive value of alarming symptoms reported by parents for complicated illness should be reconsidered