Study protocol: Cost effectiveness of two strategies to implement the NVOG guidelines on hypertension in pregnancy: An innovative strategy including a computerised decision support system compared to a common strategy of professional audit and feedback, a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Hypertensive disease in pregnancy remains the leading cause of maternal mortality in the Netherlands. Seventeen percent of the clinical pregnancies are complicated by hypertension and 2% by preeclampsia. The Dutch Society of Obstetrics and Gynaecology (NVOG) has developed evidence-based guidelines on the management of hypertension in pregnancy and chronic hypertension. Previous studies showed a low adherence rate to other NVOG guidelines and a large variation in usual care in the different hospitals. An explanation is that the NVOG has no general strategy of practical implementation and evaluation of its guidelines. The development of an effective and cost effective implementation strategy to improve adherence to the guidelines on hypertension in pregnancy is needed.</p> <p>Methods/Design</p> <p>The objective of this study is to assess the cost effectiveness of an innovative implementation strategy of the NVOG guidelines on hypertension including a computerised decision support system (BOS) compared to a common strategy of professional audit and feedback. A cluster randomised controlled trial with an economic evaluation alongside will be performed. Both pregnant women who develop severe hypertension or pre-eclampsia and professionals involved in the care for these women will participate. The main outcome measures are a combined rate of major maternal complications and process indicators extracted from the guidelines. A total of 472 patients will be included in both groups. For analysis, descriptive as well as regression techniques will be used. A cost effectiveness and cost utility analysis will be performed according to the intention-to-treat principle and from a societal perspective. Cost effectiveness ratios will be calculated using bootstrapping techniques.</p

Are luminescent bacteria suitable for online detection and monitoring of toxic compounds in drinking water and its sources?

Biosensors based on luminescent bacteria may be valuable tools to monitor the chemical quality and safety of surface and drinking water. In this review, an overview is presented of the recombinant strains available that harbour the bacterial luciferase genes luxCDABE, and which may be used in an online biosensor for water quality monitoring. Many bacterial strains have been described for the detection of a broad range of toxicity parameters, including DNA damage, protein damage, membrane damage, oxidative stress, organic pollutants, and heavy metals. Most lux strains have sensitivities with detection limits ranging from milligrams per litre to micrograms per litre, usually with higher sensitivities in compound-specific strains. Although the sensitivity of lux strains can be enhanced by various molecular manipulations, most reported detection thresholds are still too high to detect levels of individual contaminants as they occur nowadays in European drinking waters. However, lux strains sensing specific toxic effects have the advantage of being able to respond to mixtures of contaminants inducing the same effect, and thus could be used as a sensor for the sum effect, including the effect of compounds that are as yet not identified by chemical analysis. An evaluation of the suitability of lux strains for monitoring surface and drinking water is therefore provided

A record high 150 GHz f\u3csub\u3emax\u3c/sub\u3e realized at 0.18 μm gate length in an industrial RF-CMOS technology

\u3cp\u3eWe demonstrate that by careful layout optimisation, particularly aimed at reducing the effective gate resistance, a record high maximum oscillation frequency f\u3csub\u3emax\u3c/sub\u3e of 150 GHz can be obtained for an industrial 0.18 μm CMOS process showing a cut-off frequency f\u3csub\u3eT\u3c/sub\u3e of 70 GHz. A very low minimum noise figure and good suppression of the substrate noise using a guard-ring is also shown.\u3c/p\u3

Erysiphe trifolii is able to overcome er1 and Er3, but not er2, resistance genes in pea

Until recently, Erysiphe pisi was thought to be the only causal agent of powdery mildew in pea, but recent studies showed that other species such as Erysiphe trifolii and Erysiphe baeumleri can also cause this disease. Three genes, er1, er2 and Er3, conferring resistance to E. pisi have been reported so far in pea. Previous studies showed that E. trifolii and E. baeumleri were able to overcome er1 resistance, but whether er2 and Er3 were effective against E. trifolii was not known. In this study, pea accessions carrying these three genes were evaluated for resistance to E. trifolii under controlled conditions at 20 and 25 °C. In addition, these accessions were also evaluated under field conditions in Spain and in India. Analysis of the ribosomal DNA (rDNA) internal transcribed spacer (ITS) sequences showed that E. trifolii was the causal agent of powdery mildew symptoms in lines carrying er1 in Spain and that this pathogen was also present in India. Our results showed that E. trifolii was able to overcome er1 and shows that this pathogen can also overcome Er3 resistance in some conditions. In contrast, er2 provided high level of resistance against E. trifolii in all conditions and locations studied. Temperature affected the expression of Er3 against E. trifolii, but not of er1 or er2. The pea accession JI2480, containing er2, was highly resistant and JI2302 containing er1 was susceptible to E. trifolii at both temperatures, whereas P660-4 containing Er3 was resistant at 20 °C but susceptible at 25 °C. The present study also identified sources of resistance effective against both E. pisi and E. trifolii. © 2013 KNPV.Financial support from project AGL2011-22524 (co-financed by FEDER) is acknowledged.Peer reviewe