Blijvend verbeteren. Evaluatie van het wijkverbeteringsproject 'Tuindorp om te blijven' in de wijk Tuindorp in Coevorden

Blijvend verbeteren. Evaluatie van het wijkverbeteringsproject 'Tuindorp om te blijven' in de wijk Tuindorp in Coevorden Dit rapport bevat de evaluatie van de sociale component van het project 'Tuindorp om te blijven'. Om het onderzoek uit te voeren is gebruik gemaakt van de aanwezige documentatie betreffende het project, van gesprekken met de sociale spelers en er is een enquête gehouden onder de buurtbewoners. Het project 'Tuindorp om te blijven' startte in 1998 en werd gekenmerkt door een integrale en interactieve aanpak. Niet alleen de toestand van de woningen maar ook de woonomgeving en de sociale en sociaal-economische situatie in Tuindorp vroegen om aandacht. De gemeente Coevorden en de woningstichting Domesta besloten tot samenwerking om de situatie op de verschillende terreinen te kunnen verbeteren. Daarnaast was een belangrijke rol weggelegd voor de politie, het opbouwwerk en de Buurt en Speeltuinvereniging (BSV). Ook de bewoners werden actief betrokken bij het project. Hun stem was van doorslaggevend belang bij de besluitvorming en uitvoering

A generic method for hydrological drought identification across different climate regions

Peer reviewedPublisher PD

Initiation of home mechanical ventilation at home:A randomised controlled trial of efficacy, feasibility and costs

SummaryIntroductionHome mechanical ventilation (HMV) in the Netherlands is normally initiated in hospital, but this is expensive and often a burden for the patient. In this randomised controlled study we investigated whether initiation of HMV at home in patients with chronic respiratory failure is non-inferior to an in hospital based setting.MethodsSeventy-seven patients were included, of which 38 patients started HMV at home. All patients were diagnosed with chronic respiratory failure due to a neuromuscular or thoracic cage disease. Primary outcome was the arterial carbon dioxide (PaCO2) while quality of life and costs were secondary outcomes. Telemonitoring was used in the home group to provide therapeutic information, for example; transcutaneous carbon dioxide, oxygen saturation and ventilator information, to the caregivers. Follow-up was six months.ResultsPaCO2, improved by 0.72 (SE ± 0.16) kPa in the hospital group and by 0.91 (±0.20) in the home group, both improvements being significant and the latter clearly not inferior.There were also significant improvements in quality of life in both groups, again not being inferior with home treatment.ConclusionThis study is the first to show that initiation of HMV at home in a selective group of patients with chronic respiratory failure is as effective for gas exchange and quality of life as hospital initiation. In addition we found that it is safe, technically feasible and that more than € 3000 per patient can be saved compared to our standard care

Imaging cardiac innervation in amyloidosis

Cardiac amyloidosis is a form of restrictive cardiomyopathy resulting in heart failure and potential risk on arrhythmia, due to amyloid infiltration of the nerve conduction system and the myocardial tissue. The prognosis in this progressive disease is poor, probably due the development of cardiac arrhythmias. Early detection of cardiac sympathetic innervation disturbances has become of major clinical interest, because its occurrence and severity limits the choice of treatment. The use of iodine-123 labelled metaiodobenzylguanidine ([I-123]MIBG), a chemical modified analogue of norepinephrine, is well established in patients with heart failure and plays an important role in evaluation of sympathetic innervation in cardiac amyloidosis. [I-123]MIBG is stored in vesicles in the sympathetic nerve terminals and is not catabolized like norepinephrine. Decreased heart-to-mediastinum ratios on late planar images and increased wash-out rates indicate cardiac sympathetic denervation and are associated with poor prognosis. Single photon emission computed tomography provides additional information and has advantages for evaluating abnormalities in regional distribution in the myocardium. [I-123]MIBG is mainly useful in patients with hereditary and wild-type ATTR cardiac amyloidosis, not in AA and AL amyloidosis. The potential role of positron emission tomography for cardiac sympathetic innervation in amyloidosis has not yet been identified

Intensification of the North American Monsoon Rainfall as Observed From a Long‐Term High‐Density Gauge Network

As the atmosphere gets warmer, rainfall intensification is expected across the planet with anticipated impacts on ecological and human systems. In the southwestern United States and northwestern Mexico, the highly variable and localized nature of rainfall during the North American Monsoon makes it difficult to detect temporal changes in rainfall intensities in response to climatic change. This study addresses this challenge by using the dense, subdaily, and daily observations from 59 rain gauges located in southeastern Arizona. We find an intensification of monsoon subdaily rainfall intensities starting in the mid-1970s that has not been observed in previous studies or simulated with high-resolution climate models. Our results highlight the need for long-term, high spatiotemporal observations to detect environmental responses to a changing climate in highly variable environments and show that analyses based on limited observations or gridded data sets fail to capture temporal changes potentially leading to erroneous conclusions.Public domain articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

"A randomized trial of initiation of chronic non-invasive mechanical ventilation at home vs in-hospital in patients with Neuromuscular Disease and thoracic cage disorder":The Dutch Homerun Trial

Background: There is an increasing demand for home mechanical ventilation (HMV) in patients with chronic respiratory insufficiency. At present, noninvasive ventilation is exclusively initiated in a clinical setting at all four centers for HMV in the Netherlands. In addition to its high societal costs and patient discomfort, commencing HMV is often delayed because of a lack of hospital bed capacity. Research Question: Is HMV initiation at home, using a telemonitoring approach, noninferior to in-hospital initiation in a nationwide study? Study Design and Methods: We conducted a nationwide, randomized controlled noninferiority trial, in which every HMV center recruited 24 patients (home [n = 12] vs hospital [n = 12]) with a neuromuscular disease or thoracic cage disorder, all with an indication to start HMV. Change in arterial CO 2 (PaCO 2) over a 6-month period was considered the primary outcome, and quality of life and costs were assessed as secondary outcomes. Results: A total of 96 patients were randomized, most of them diagnosed with neuromuscular disease. We found a significant improvement in PaCO 2 within both groups (home: from 6.1 to 5.6 kPa [P <.01]; hospital: from 6.3 to 5.6 kPa [P <.01]), with no significant differences between groups. Health-related quality of life showed significant improvement on various subscales; however, no significant differences were observed between the home and hospital groups. From a societal perspective, a cost reduction of more than €3,200 ($3,793) per patient was evident in the home group. Interpretation: This nationwide, multicenter study shows that HMV initiation at home is noninferior to hospital initiation, as it shows the same improvement in gas exchange and health-related quality of life. In fact, from a patient's perspective, it might even be a more attractive approach. In addition, starting at home saves over €3,200 ($3,793) per patient over a 6-month period. Trial Registry: ClinicalTrials.gov; No.: NCT03203577; URL: www.clinicaltrials.gov