Historische Wortels van het Recht

bookFdR – Publicaties zonder aanstelling Universiteit Leide

Research Programme to Improve the Utilization of Home-Grown forages in the Netherlands

In The Netherlands a research programme has been initiated by the Ministry of Agriculture, Nature Management and Fisheries to increase the proportion of high-quality home-grown forage in rations for dairy cows. This should result in a more sustainable dairy husbandry by improving the efficiency of utilization of nitrogen and phosphorus from home-grown forages (mainly grass and maize) on farm level. Research disciplines involved are plant breeding, forage harvesting and conservation and nutrition

Schatting van de uitscheiding van stikstof en fosfor door diverse categorieën graasdieren

Expertisecentrum LNV heeft de Animal Sciences Group benaderd met de vraag de forfataire stikstof (N)- en fosfor (P) excreties zoals die door Tamminga et al.(2000) voor een aantal diercategorieën zijn afgeleid te herberekenen en zo nodig bij te stellen, of deze af te leiden voor zover er nog geen excretiegetallen voorhanden zijn. Tevens is gevraagd voor zover relevant het aantal diercategorieën te verminderen

Lage ciclosporinespiegel na kort rifampicinegebruik : immuunsuppressie kan langdurig tekortschieten

Cyclosporin is an immunosuppressive agent with a wide range of therapeutic uses. In transplant patients, it is used for the prevention of rejection and graft-versus-host reactions. The metabolism and bioavailability of cyclosporin can be significantly and persistently influenced through induction of CYP3A4 caused by the concomitant use of rifampicin. However, awareness of the need for the timely and frequent monitoring of cyclosporin levels during and especially after treatment with rifampicin has not fully been addressed. Here, we describe 3 patient cases concerning significant episodes of sub-therapeutic cyclosporin levels after short-term rifampicin therapy. Rifampicin was administered for three to five days and decreased cyclosporin levels were observed ± 7 days after the initiation of rifampicin, and continued during the following weeks even after the cessation of rifampicin therapy. Cyclosporin dosage-adjustments were made based on the cyclosporin blood levels and all 3 patients showed good therapeutic and clinical responses.Zelfs kortdurend gebruik van het antibioticum rifampicine kan de ciclosporineconcentratie in het bloed verlagen. Daarom moet de bloedspiegel van dit immunosuppressivum goed gemonitord worden bij patiënten die ook rifampicine krijgen, ook als de patiënt al gestopt is met het middel. Om afstoting van transplantaten of graft-versus-hostreacties te voorkómen, is het vaak nodig de ciclosporinedosering aan te passen

The impact of roughness elements on sediment fluxes in coastal dunes and dune valleys: solving the puzzle for Spanjaards Duin

In 2009 a new dune area called Spanjaards Duin was constructed in front of the Delfland Coast. Spanjaards Duin was created as a compensation measure for the expected increase in nitrogen deposition from the expansion of the Rotterdam harbour (Maasvlakte 2). The predefined compensation goal is to reach 6 ha of moist dune slack vegetation and 10 ha of dry grey dune in 2033. This is pursued by creating favourable abiotic conditions for natural vegetation establishment (van der Meulen et al., 2014). Sediment fluxes affect establishment and growth of vegetation and shape the dune landscape. Therefore, there is need to know how sediment fluxes behave in Spanjaards Duin

Medical treatment of octogenarians with chronic heart failure: data from CHECK-HF

Background: Elderly heart failure (HF) patients are underrepresented in clinical trials, though are a large proportion of patients in real-world practice. We investigated practice-based, secondary care HF management in a large group of chronic HF patients aged ≥ 80 years (octogenarians). Methods: We analyzed electronic health records of 3490 octogenarians with chronic HF at 34 Dutch outpatient clinics in the period between 2013 and 2016 , 49% women. Study patients were divided into HFpEF [LVEF ≥ 50%; n = 911 (26.1%)], HFrEF [LVEF < 40%; n = 2009 (57.6%)] and HF with mid-range EF [HFmrEF: LVEF 40–49%; n = 570 (16.3%)]. Results: Most HFrEF patients aged ≥ 80 years received a beta blocker and a renin–angiotensin system (RAS) inhibitor (angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker), i.e. 78.3% and 72.8% respectively, and a mineralocorticoid receptor antagonist (MRA) was prescribed in 52.0% of patients. All three of these guideline-recommended medications (triple therapy) were given in only 29.9% of octogenarians with HFrEF, and at least 50% of target doses of triple therapy, beta blockers, RAS inhibitor and MRA, were prescribed in 43.8%, 62.2% and 53.5% of the total group of HFrEF patients. Contraindications or intolerance for beta blockers was present in 3.5% of the patients, for RAS inhibitors and MRAs in, 7.2% and 6.1% Conclusions: The majority of octogenarians with HFrEF received one or more guideline-recommended HF medications. However, triple therapy or target doses of the medications were prescribed in a minority. Comorbidities and reported contraindications and tolerances did not fully explain underuse of recommended HF therapies. Graphic abstract: [Figure not available: see fulltext.]

Health outcomes and cost-effectiveness of monoclonal SARS-CoV-2 antibodies as pre-exposure prophylaxis

IMPORTANCE Pre-exposure prophylaxis with neutralizing SARS-CoV-2 monoclonal antibodies (mAbs PrEP) prevents infection and reduces hospitalizations and the duration thereof for COVID-19 and death among high-risk individuals. However, reduced effectiveness due to a changing SARS-CoV-2 viral landscape and high drug prices remain substantial implementation barriers.OBJECTIVE To assess the cost-effectiveness of mAbs PrEP as COVID-19 PrEP.DESIGN, SETTING, AND PARTICIPANTS For this economic evaluation, a decision analytic model was developed and parameterized with health care outcome and utilization data from individuals with high risk for COVID-19. The SARS-CoV-2 infection probability, mAbs PrEP effectiveness, and drug pricing were varied. All costs were collected from a third-party payer perspective. Data were analyzed from September 2021 to December 2022.MAIN OUTCOMES AND MEASURES Health care outcomes including new SARS-CoV-2 infections, hospitalization, and deaths. The cost per death averted and cost-effectiveness ratios using a threshold for prevention interventions of $22000 or less per quality-adjusted life year (QALY) gained.RESULTS The clinical cohort consisted of 636 individuals with COVID-19 (mean [SD] age 63 [18] years; 341 [54$275 and 75% or higher effectiveness. With a 100% effectiveness mAbs PrEP can reduce ward admissions by 70%, ICU admissions by 97%, and deaths by 92%. Drug prices, however, need to reduce to $550 for cost-effectiveness ratios less than$22000 per QALY gained per death averted and to $2200 for ratios between$22000 and $88000.CONCLUSIONS AND RELEVANCE In this study, use of mAbs PrEP for preventing SARS-CoV-2 infections was cost-saving at the beginning of an epidemic wave (high infection probability) with 75$275. These results are timely and relevant for decision-makers involved in mAbs PrEP implementation. When newer mAbs PrEP combinations become available, guidance on implementation should be formulated ensuring a fast rollout. Nevertheless, advocacy for mAbs PrEP use and critical discussion on drug prices are necessary to ensuring cost-effectiveness for different epidemic settings.Clinical epidemiolog