Doing more with less : concise and standard treatment for depressive and anxiety disorders compared in clinical practice

  In this thesis the effectiveness of concise formats of psycho- and/or pharmacotherapy (concise care) in patients suffering from mild to moderate depressive and anxiety disorders in secondary mental health care is evaluated. A pragmatic randomised controlled equivalence trial was set up and carried out as part of routine clinical practice. Evidence for equivalence of concise care compared with standard care was found. Severity of illness was reduced and general health status and subdomains of quality of life improved in both conditions. Moreover, in concise care, the beneficial effects started earlier and patients were more satisfied with overall treatment than patients in standard care. No significant differences in healthcare costs between both treatments were found. In addition, patients suffering from any anxiety disorder (without comorbid depressive disorder) benefitted less from concise care than from standard care. No other clinical or demographic factors were associated with differential treatment effects. Exploring the agreement between a brief screening questionnaire (the Web Screening Questionnaire (WSQ)), and the gold standard diagnostic interview MINI-Plus, reveals that the WSQ is a good screening tool for depressive and anxiety disorders in clinical practice and it might be a further step in the economization and optimization of mental healthcare.  LUMC / Geneeskund

A membrane reformer with permeate side combustion for CO2 capture: Modeling and design

AbstractThe design of a pre-combustion natural gas fired power plant is presented, which makes use of a membrane assisted reformer with permeate side combustion. A detailed reactor model has been made with which the impact of the air distribution pattern is assessed. The results demonstrate that a flat air distribution pattern is sufficient for avoiding hot spots in the reactor. A system assessment shows that the concept is competitive with conventional membrane reformers in terms of system efficiency, and offers a more compact design

Population balances combined with computational fluid dynamics : a modeling approach for dispersive mixing in a high pressure homogenizer

High pressure homogenization is at the heart of many emulsification processes in the food, personal care and pharmaceutical industry. The droplet size distribution is an important property for product quality and is aimed to be controlled in the process. Therefore a population balance model was built in order to predict the droplet size distribution subject to various hydrodynamic conditions found in a high pressure homogenizer. The hydrodynamics were simulated using Computational Fluid Dynamics and the turbulence was modeled with a RANS k–e model. The high energy zone in the high pressure homogenizer was divided into four compartments. The compartments had to be small enough to secure nearly homogeneous turbulent dissipation rates but large enough to hold a population of droplets. A population balance equation describing breakage and coalescence of oil droplets in turbulent flow was solved for every compartment. One set of parameters was found which could describe the development of the droplet size distribution in the high pressure homogenizer with varying pressure drop. An improvement of 65% was found compared to the same model containing just one compartment. The compartment approach may provide an alternative to direct coupling of CFD and population balances