The role of the neighbourhood for firms that stayed- or left

This paper looks at the factors that influence an entrepreneur's decision to stay or move out of a neighbourhood. In general, new and relatively small firms tend to have a strong connection to their local environment and hardly ever move across large distances. In the Netherlands, 75% of all moving firms even stays within the same municipality, to business parks or to other neighbourhoods (RPB, 2007). Aspects of the building (e.g. size) are the most likely reason to move, but does the neighbourhood itself matter as well? We look to what extent neighbourhood aspects influence or have influenced the decision to stay or move, both on the push and the pull side. These aspects may be related to the local physical environment or the safety situation, but also to the local social community. There is recent evidence that localized firm support network contacts contribute positively to firm success (Sleutjes & Schutjens, 2009). Local personal and professional relationships may tie firms to their local environment. If certain neighbourhood characteristics or localized networks turn out to be pull or push factors for entrepreneurs, this might interest policy makers aiming at stimulating the neighbourhood economy by attracting and retaining entrepreneurs within certain urban neighbourhoods. Basically, three questions will be answered in this paper: 1. To what extent do social and physical neighbourhood characteristics play a role in a firm's decision to stay or move? 2. How do localized firm support networks influence a firm's decision to stay put within a certain neighbourhood or not? 3. To what extent do moving firms keep in touch with local network contacts from their former neighbourhood? We conducted in-depth semi-structured interviews among 40 entrepreneurs from five similar Dutch neighbourhoods. The sample is equally divided between firms that stayed and firms that recently moved out of the neighbourhood (20/20). The survey provides detailed information on the characteristics and the performance of firms, as well as network contacts, neighbourhood attachment, location choice, and the valuation of location aspects. We make use of qualitative methods in order to analyze our data

Cardiovascular risk in inflammatory bowel disease:More than a gut feeling

Patients with inflammatory bowel disease (IBD) have an increased risk of both venous thromboembolism (VTE) and atherosclerotic cardiovascular disease (ASCVD) compared to the general population. Improved cardiovascular prevention and management strategies are of utmost importance to protect our vulnerable IBD population. Up until now, literature suggested the idea of a so-called “cardiovascular paradox” in IBD: an increased incidence of ASCVD despite similar or even lower prevalence of traditional cardiovascular risk factors. This paradox is refuted as IBD patients show unfavorable cardiovascular risk profiles that align with the metabolic syndrome. Inflammation is a promising new therapeutic target for ASCVD prevention. Cardiovascular (side)effects of IBD treatment should be taken into account in the risk-benefit balance for patient-centered clinical decision making. Prednisone and tofacitinib may increase lipid levels, in contrast to other registered IBD drugs. Therefore, routine evaluation of lipid profiles in IBD patients with active disease initiating these drugs in clinical practice is supported. Challenges in cardiovascular risk management in IBD patients include limited available guidance, and the inability of commonly used clinical risk calculators to fully capture long-term ASCVD risk. The implementation of a standardized cardiovascular screening program in daily IBD care seems feasible. Adequately designed longitudinal studies in large cohorts are essential to clarify the contribution of both traditional and IBD-related factors to excess CVD risk in IBD. The development of accurate IBD-specific risk predictors and exploring the yield of screening and interventions on ASCVD outcomes in IBD are crucial

Cardiovascular risk in inflammatory bowel disease:More than a gut feeling

Patients with inflammatory bowel disease (IBD) have an increased risk of both venous thromboembolism (VTE) and atherosclerotic cardiovascular disease (ASCVD) compared to the general population. Improved cardiovascular prevention and management strategies are of utmost importance to protect our vulnerable IBD population. Up until now, literature suggested the idea of a so-called “cardiovascular paradox” in IBD: an increased incidence of ASCVD despite similar or even lower prevalence of traditional cardiovascular risk factors. This paradox is refuted as IBD patients show unfavorable cardiovascular risk profiles that align with the metabolic syndrome. Inflammation is a promising new therapeutic target for ASCVD prevention. Cardiovascular (side)effects of IBD treatment should be taken into account in the risk-benefit balance for patient-centered clinical decision making. Prednisone and tofacitinib may increase lipid levels, in contrast to other registered IBD drugs. Therefore, routine evaluation of lipid profiles in IBD patients with active disease initiating these drugs in clinical practice is supported. Challenges in cardiovascular risk management in IBD patients include limited available guidance, and the inability of commonly used clinical risk calculators to fully capture long-term ASCVD risk. The implementation of a standardized cardiovascular screening program in daily IBD care seems feasible. Adequately designed longitudinal studies in large cohorts are essential to clarify the contribution of both traditional and IBD-related factors to excess CVD risk in IBD. The development of accurate IBD-specific risk predictors and exploring the yield of screening and interventions on ASCVD outcomes in IBD are crucial

Ectopic Motor Unit Activity in Motor Neuron Disease

__Abstract__ Motor neuron disease (MND) is characterized by the progressive loss of motor neurons that control voluntary muscles. Due to its progressive nature, the muscles gradually lose their function leading to paralysis and, ultimately, death. The most common variant of MND is amyotrophic lateral sclerosis (ALS). Of all the people diagnosed with ALS, 50% die within approximately two to three years after their first symptoms arise and only about 20% live longer than 5 years [1]. Onset is typically around 50 - 70 years of age, but in some patients the onset may be much earlier, around the age of 20 - 30 years. Incidence is higher among men than women, estimated at 2:1 [2-4]. The first symptoms usually occur in the limbs, but muscle weakness may also begin in the bulbar region. Progressive weakness of the respiratory muscles leading to respiratory failure is the most common cause of death. Before the first clinical signs of muscle weakness become apparent, more than 50% of the motor neurons innervating a muscle may already be lost [5]. In the Netherlands, approximately 1,700 people (prevalence 10.3 per 100,000) suffer from ALS [2]. Every year, approximately 500 people (incidence 2.8 per 100,000) in the Netherlands are diagnosed with ALS [2], and about the same number of persons dies every year. In comparison, approximately 570 people in the Netherlands died in traffic accidents in 2013 [6]. The term ALS was first described in 1874 by Jean-Martin Charcot [7]. Despite the tremendous technological progress that has been made in the last 140 years and despite numerous studies that have been conducted to unravel the mechanisms that may cause this deadly disease, relatively little is known about the mechanisms that cause ALS and the progressive degeneration of motor neurons is often unpredictable. The great majority of patients is classified as having sporadic ALS, and only 5 - 10% of the patients have a familial history of this disease. A complex interaction between genetic and environmental factors is believed to contribute to the development of the disease. Several genes have been identified and their discovery gave new insights into the underlying pathophysiological mechanisms. At present, no cure is available, and the only approved and widely used medication (Riluzole) can only marginally slow down the progression of the disease by approximately 3 months [8]. In this section, first the concept of a motor unit as a crucial component being affected by MND will be introduced, together with some basics on how motor units are affected in this condition. Next, one of the most obvious clinical signs, fasciculations, will be discussed, followed by the varying clinical phenotypes. Subsequently, the difficulties in the diagnostic process and the prognosis will be described. Currently, both can be very difficult, especially in the early stages of the disease, even with a thorough clinical and electrodiagnostic examination