Numerical modelling of physical processes governing larval transport in the southern North Sea

A three-dimensional hydrodynamic model (GETM) was coupled with a particle tracking routine (GITM) to study the inter-annual variability in transport paths of particles in the North Sea and English Channel. For validation, a comparison with observed drifter trajectories is also presented here. This research investigated to what extent variability in the hydrodynamic conditions alone (reflecting passive particle transport) contributed to inter-annual variability in the transport of eggs and larvae. In this idealised study, no a priori selection of specific spawning grounds or periods was made and no active behaviour (vertical migration) or mortality was included. In this study, egg and larval development towards coastal nursery areas was based solely on sea water temperature, while settlement areas were defined by a threshold water depth. Results showed strong inter-annual variability in drift direction and distance, caused by a combination of wind speed and direction. Strong inter-annual variability was observed both in absolute amount of settlement in several coastal areas, and in the relative importance of the different areas. The effects of wind and temperature variability are minor for settlement along the western shores of the North Sea and in the English Channel, but have a very significant impact on settlement along the eastern shores of the North Sea. Years with strong south-westerly winds across the Dover Straight resulted in higher settlement figures along its eastern shores of the North Sea (standard deviation 37% of the mean annual settlement value). Settlement in the western Dutch Wadden Sea did not only show inter-annual variability, but patterns were also variable within each year and revealed seasonal changes in the origin of particles: during winter, stronger currents along with colder temperatures generally result in particles originating from further away

Three Years of Δ14CO2 Observations from Maize Leaves in the Netherlands and Western Europe

Atmospheric Δ14CO2 measurements are useful to investigate the regional signals of anthropogenic CO2 emissions, despite the currently scarce observational network for Δ14CO2. Plant samples are an easily attainable alternative, which have been shown to work well as a qualitative measure of the atmospheric Δ14CO2 signals integrated over the time a plant has grown. Here, we present the 14C analysis results for 89 individual maize (Zea mays) plant samples from 51 different locations that were gathered in the Netherlands in the years 2010 to 2012, and from western Germany and France in 2012. We describe our sampling strategy and results, and include a comparison to a model simulation of the Δ14CO2 that would be accumulated in each plant over a growing season. Our model simulates the Δ14CO2 signatures in good agreement with observed plant samples, resulting in a root-mean-square deviation (RMSD) of 3.30‰. This value is comparable to the measurement uncertainty, but still relatively large (20–50%) compared to the total signal. It is also comparable to the spread in Δ14CO2 values found across multiple plants from a single site, and to the spread found when averaging across larger regions. We nevertheless find that both measurements and model capture the large-scale (>100 km) regional Δ14CO2 gradients, with significant observation-model correlations in all three countries in which we collected samples. The modeled plant results suggest that the largest gradients found in the Netherlands and Germany are associated with emissions from energy production and road traffic, while in France, the 14CO2 enrichment from nuclear sources dominates in many samples. Overall, the required model-based interpretation of plant samples adds additional uncertainty to the already relatively large measurement uncertainty in Δ14CO2, and we suggest that future fossil fuel monitoring efforts should prioritize other strategies such as direct atmospheric sampling of CO2 and Δ14CO2

Comparison of pregnancy outcomes in Dutch kidney recipients with and without calcineurin inhibitor exposure:a retrospective study

Within pregnancies occurring between 1986 and 2017 in Dutch kidney transplant recipients (KTR), we retrospectively compared short-term maternal and foetal outcomes between patients on calcineurin inhibitor (CNI) based (CNI+) and CNI-free immunosuppression (CNI-). We identified 129 CNI+ and 125 CNI- pregnancies in 177 KTR. Demographics differed with CNI+ having higher body mass index (P = 0.045), shorter transplant-pregnancy interval (P < 0.01), later year of transplantation and -pregnancy (P < 0.01). Serum creatinine levels were numerically higher in CNI+ in all study phases, but only reached statistical significance in third trimester (127 vs. 105 mu m; P < 0.01), where the percentual changes from preconceptional level also differed (+3.1% vs. -2.2% in CNI-; P = 0.05). Postpartum both groups showed 11-12% serum creatinine rise from preconceptional level. Incidence of low birth weight (LBW) tended to be higher in CNI+ (52% vs. 46%; P = 0.07). Both groups showed equal high rates of preterm delivery. Using CNIs during pregnancy lead to a rise in creatinine in the third trimester but does not negatively influence the course of graft function in the first year postpartum or direct foetal outcomes. High rates of preterm delivery and LBW in KTR, irrespective of CNI use, classify all pregnancies as high risk

Primary Care Management of Asthma Exacerbations or Attacks: Impact of the COVID-19 Pandemic

The COVID-19 pandemic has brought a renewed focus on appropriate management of chronic respiratory conditions with a heightened awareness of respiratory symptoms and the requirement for differential diagnosis between an asthma attack and COVID-19 infection. Despite early concerns in the pandemic, most studies suggest that well-managed asthma is not a risk factor for more severe COVID-related outcomes, and that asthma may even have a protective effect. Advice on the treatment of asthma and asthma attacks has remained unchanged. This article describes some challenges faced in primary care asthma management in adults and in teenagers, particularly their relevance during a pandemic, and provides practical advice on asthma attack recognition, classification, treatment and continuity of care. Acute attacks, characterised by increased symptoms and reduced lung function, are often referred to as exacerbations of asthma by doctors and nurses but are usually described by patients as asthma attacks. They carry a significant and underestimated morbidity and mortality burden. Many patients experiencing an asthma attack are assessed in primary care for treatment and continuing management. This may require remote assessment by telephone and home monitoring devices, where available, during a pandemic. Differentiation between an asthma attack and a COVID-19 infection requires a structured clinical assessment, taking account of previous medical and family history. Early separation into mild, moderate, severe or life-threatening attacks is helpful for continuing good management. Most attacks can be managed in primary care but when severe or unresponsive to initial treatment, the patient should be appropriately managed until transfer to an acute care facility can be arranged. Good quality care is important to prevent further attacks and must include a follow-up appointment in primary care, proactive regular dosing with daily controller therapy and an understanding of a patient’s beliefs and perceptions about asthma to maximise future self-management

Burden and socioeconomics of asthma, allergic rhinitis, atopic dermatitis and food allergy

INTRODUCTION: Asthma, allergic rhinitis, atopic dermatitis, and food allergy affect approximately 20% of the global population. Few studies describe the burden of the totality of these diseases and only a handful studies provide a comprehensive overview of the socioeconomic impact of these diseases. AREAS COVERED: For this narrative review, we searched Pubmed using selected keywords and inspected relevant references using a snowballing process. We provide an overview of the socioeconomic burden of allergic diseases (in particular, asthma, allergic rhinitis, atopic dermatitis, and food allergy). The focus of this review is on their epidemiology (incidence, prevalence), burden (disability-adjusted life years, quality of life), and direct and indirect costs (absenteeism and presenteeism). We have put special emphasis on differences between countries. EXPERT COMMENTARY: Both the prevalence and the burden of allergic diseases are considerable with prevalence varying between 1% and 20%. We identified a plethora of studies on asthma, but studies were generally difficult to compare due to the heterogeneity in measures used. There were only few studies on the burden of food allergy; therefore, more studies on this allergy are required. For future studies, we recommend standardizing epidemiologic, socioeconomic impact, and quality of life measures of allergic diseases

Epinephrine auto-injector prescriptions to food-allergic patients in primary care in The Netherlands

BACKGROUND: The knowledge of general practitioner(s) (GPs) regarding food allergy and anaphylaxis and practices in the prescription of epinephrine auto-injector(s) (EAIs) among GPs has previously only been studied using questionnaires and hypothetical cases. Therefore, there are currently no data as to whether or not GPs prescribe EAIs to high risk food-allergic patients presenting to primary care practices. The aim of this study was therefore to describe and evaluate practice in EAI prescription by GPs to food-allergic patients in The Netherlands. METHODS: Patients aged 12–23 years who consulted their GP for allergic symptoms were identified in a primary care database. Patients were classified as probably or unlikely to be food-allergic. A risk factor assessment was done to identify probably food-allergic patients at high risk for anaphylaxis to assess the need for an EAI. RESULTS: One hundred forty-eight out of 1015 patients consulted their GP for allergic symptoms due to food. Eighty patients were excluded from analysis because of incomplete records. Thirty-four patients were classified as probably food-allergic. Twenty-seven of them were considered high risk patients and candidates for an EAI. Importantly, only 10 of them had actually been prescribed an EAI by their GP. CONCLUSIONS: This study shows that high risk food-allergic patients that visit their GPs are often not prescribed an EAI. Thus, previously identified low rates of EAI ownership may be partly due to GPs not prescribing this medication to patients for whom it would be appropriate to do so. These data suggest that there is a need for improvement of the quality of care for high risk food-allergic patients in primary care

Effects of mixed versus blocked design on stimulus evaluation: combining underaddative effects.

(from the journal abstract) According to the asynchronous discrete coding model of Miller, two manipulations should display underadditive effects on reaction time if they slow down noncontingent stages associated with the processing of two separable dimensions of a stimulus. Underadditive effects are also predicted by a dual route model when a task variable is factorially varied with design type (mixed vs blocked). Interpretations of both underadditive effects and their combination were evaluated. Intact and degraded stimuli were presented to 18 young adults either in a single block (mixed) or in separate blocks (blocked). Spatial stimulus-response (S-R) compatibility was manipulated in all conditions. Stimulus degradation and S-R compatibility interacted underadditively, but only in blocked presentations. Both interpretations of underadditive effects were supported. Eye-movement registrations provided additional support for the alternative routes model

Assessing health status over time:Impact of recall period and anchor question on the minimal clinically important difference of copd health status tools

BACKGROUND: The Minimal Clinically Important Difference (MCID) assesses what change on a measurement tool can be considered minimal clinically relevant. Although the recall period can influence questionnaire scores, it is unclear if it influences the MCID. This study is the first to examine longitudinally the impact of the recall period of an anchor question and its design on the MCID of COPD health status tools using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and the St. George's Respiratory Questionnaire (SGRQ). METHODS: Moderate to very severe COPD patients without respiratory co-morbidities were recruited during 3-week Pulmonary Rehabilitation (PR). CAT, CCQ and SGRQ were completed at baseline, discharge, 3, 6, 9 and 12 months. A 15-point Global Rating of Change scale (GRC) was completed at each follow-up. A five-point GRC was used as second anchor at 12 months. Mean change scores of a subset of patients indicating a minimal improvement on each of the anchor questions were considered the MCID. The MCID estimates over different time periods were compared with one another by evaluating the degree of overlap of Confidence Intervals (CI) adjusted for dependency. RESULTS: In total 451 patients were included (57.9 ± 6.6 years, 65% male, 50/39/11% GOLD II/III/IV), of which 309 completed follow-up. Baseline health status scores were 20.2 ± 7.3 (CAT), 2.9 ± 1.2 (CCQ) and 50.7 ± 17.3 (SGRQ). MCID estimates for improvement ranged - 3.1 to - 1.4 for CAT, - 0.6 to - 0.3 for CCQ, and - 10.3 to - 7.6 for SGRQ. Absolute higher - though not significant - MCIDs were observed for CAT and CCQ directly after PR. Significantly absolute lower MCID estimates were observed for CAT (difference - 1.4: CI -2.3 to - 0.5) and CCQ (difference - 0.2: CI -0.3 to -0.1) using a five-point GRC. CONCLUSIONS: The recall period of a 15-point anchor question seemed to have limited impact on the MCID for improvement of CAT, CCQ and SGRQ during PR; although a 3-week MCID estimate directly after PR might lead to absolute higher values. However, the design of the anchor question was likely to influence the MCID of CAT and CCQ. TRIAL REGISTRATION: RIMTCORE trial # DRKS00004609 and #12107 (Ethik-Kommission der Bayerischen Landesärztekammer)