A lower global lung ultrasound score is associated with higher likelihood of successful extubation in invasively ventilated COVID-19 patients

Lung ultrasound (LUS) can be used to assess loss of aeration, which is associated with outcome in patients with coronavirus disease 2019 (COVID-19) presenting to the emergency department. We hypothesized that LUS scores are associated with outcome in critically ill COVID-19 patients receiving invasive ventilation. This retrospective international multicenter study evaluated patients with COVID-19-related acute respiratory distress syndrome (ARDS) with at least one LUS study within 5 days after invasive mechanical ventilation initiation. The global LUS score was calculated by summing the 12 regional scores (range 0-36). Pleural line abnormalities and subpleural consolidations were also scored. The outcomes were successful liberation from the ventilator and intensive care mortality within 28 days, analyzed with multistate, competing risk proportional hazard models. One hundred thirty-seven patients with COVID-19-related ARDS were included in our study. The global LUS score was associated with successful liberation from mechanical ventilation (hazard ratio [HR]: 0.91 95% confidence interval [CI] 0.87-0.96; P = 0.0007) independently of the ARDS severity, but not with 28 days mortality (HR: 1.03; 95% CI 0.97-1.08; P = 0.36). Subpleural consolidation and pleural line abnormalities did not add to the prognostic value of the global LUS score. Examinations within 24 hours of intubation showed no prognostic value. To conclude, a lower global LUS score 24 hours after invasive ventilation initiation is associated with increased probability of liberation from the mechanical ventilator COVID-19 ARDS patients, independently of the ARDS severity.Pathogenesis and treatment of chronic pulmonary disease

Public-Private or Private-Private Energy Partnerships? Towards Good Public Governance in green gas projects

Background: An important avenue toward a proper ‘energy transition’ through regional and local projects is for government to collaborate with private sector organizations. In the energy sector, these latter organizations are often already involved in private-private partnerships for collaboration toward energy transition. This article focuses on the energy governance question whether in fact some of these forms of collaboration actually are about public governance, as they effectively lean on government involvement. This seems to be the case in the construction of biogas infrastructures for the production and distribution of green gas. This contribution discusses, on the basis of the case ‘Biogas grid Noordoost Fryslân’, if such collaboration should in fact be labeled as public-private partnership (PPP). In the energy governance discourse, this issue is important because in the organization of PPP, the public interest of energy transition comes with specific normative safeguards, originating in public law. Methods: This article provides a legal normative assessment on the basis of a specific case, the Biogas grid Noordoost Fryslân. The relevant empirical data on this case is gathered by a document study, including research reports, policy plans, project documents, and by interviews. Experts from the Dutch energy sector were face-to-face interviewed by a semi-structured questionnaire. The analysis uses the concept of PPP in relation to public authority. Results: On the basis of a confrontation between the results from literature and from the results of empirical case study of a biogas grid in the Dutch region Noordoost Fryslân, we conclude that governmental influence can take a ‘disguised’ form by ‘quasi’ private organizations, with major normative consequences for the mode of sustainable energy governance. Conclusions: Administrative law in particular poses (binding) criteria for safeguarding public interests, such as on transparency, relevant also to the mode of governance applied in the promotion of renewable energy. Public standards for governance of renewable energy projects have to be sufficiently safeguarded, as regards their form and content of steering, while at the same time retaining the advantages, which ensue from private party involvement within PP

To PPP or not to PPP? (Public-)Private Partnerships involving green gas

To realize a proper ‘energy transition’ government has to collaborate with private sector organizations. In the energy sector these latter organizations are often already involved in private-private partnerships for collaboration towards energy transition. The question seems justified if, upon closer analysis, these forms of collaboration also come with some form of (active) input from government. This seems to be the case in the construction of biogas-infrastructures for the production and distribution of green gas. Consequently, this contribution discusses if such collaboration should in fact be labeled as Public-Private Partnership. In the governance debate, this issue is important because in the organization of PPP the public interest (in this case: energy transition) has to be properly safeguarded. On the base of a confrontation between the results from literature study and the results of empirical case study of a biogasinfrastructure in the Dutch region ‘Noordoost Fryslân’, we conclude that governmental influence can take a veiled form by ‘quasi’ private organizations. Law in particular, provides (binding) criteria for safeguarding public interests, such as on transparency, relevant also to the promotion of renewable energy. Public standards for these types of projects has to be sufficiently safeguarded, as regard to their form and content of steering, while at the same time retaining the advantages which ensue from the collaborative character of PPP

“Meet Me Halfway,” Said the Robot to the Regulation: Linking Ex-Ante Technology Impact Assessments to Legislative Ex-Post Evaluations via Shared Data Repositories for Robot Governance

Current legislation may apply to new developments. Even so, these developments may raise new challenges that call into question the applicability of this legislation. This paper explains what happens at this moment for new robot technologies. We argue that there is no formal communication process between robot developers and regulators from which policies could learn. To bridge this gap, we propose a model that links technology impact assessments to legislative ex-post evaluations via shared data repositories

Behoefte aan uniforme kwaliteitscyclus van coschappen

OBJECTIVE: To investigate how quality control of clinical placements in the Netherlands is organised, which tools are available for this purpose, and what Dutch clinical placement students think about current clinical placement assessment. DESIGN: Document analysis, literature search and questionnaire. METHOD: In 2017, we asked all 8 medical schools to share their procedures and tools for assessing clinical placement quality with us. We searched various databases to find all published tools developed to measure clinical placement quality. In the same year, we also conducted a survey of 15 clinical placement students per school with questions about current and desired clinical placement assessment. RESULTS: All 8 schools sent detailed information about clinical placement quality assessment contents and procedures. All schools indicated that they are cyclically measuring each clinical placement's quality using evaluations by the clinical placement students. Each school uses its own questionnaire, none of these questionnaires have been validated. Literature search only found two tools specifically developed for assessing clinical placement quality, none of which have been validated for the Dutch language and situation. Clinical placement students feel that not enough noticeable improvement actions are being taken as a result of their evaluations. They preferred a short, uniform questionnaire with questions about clinical placement content, atmosphere and organisation. CONCLUSION: The quality cycle of clinical placements in the Netherlands could be improved with respect to uniformity and implementation of actions for improvement. There is a need for standardisation of the clinical placement quality cycle and for development of a validated Dutch measuring tool for this