The energy and material related impacts of the transition towards low-carbon heating: a case study of the Netherlands

This dissertation investigates the energy and material related impacts of the transition towards a low-carbon heating system in the Netherlands, in the context of its 2050 climate and circular economy policy goals. Multiple heating system pathways for the Netherlands from 2020-2050 based on the local availability of sources of heat are used. Four main research questions are answered in this dissertation: 1. What is the size of the material stock of the current Dutch natural-gas based heating system, and can this material be used in a circular economy? 2. What are the possible development pathways and operational GHG emissions of the Dutch heating system towards 2050? 3. What are the consequences of the heating transition for the use of materials and how can this transition contribute to the circular economy transition? 4. What is the impact on GHG emissions of the transition towards a low-carbon heating system from 2021-2050? This dissertation shows that taking into account emissions related to materials has major consequences for the achievability of the Dutch climate goalsIndustrial Ecolog

This city is not a bin: crowdmapping the distribution of urban litter

Industrial Ecolog

Transitioning to low-carbon residential heating: the impacts of material-related emissions

To achieve climate neutrality, future urban heating systems will need to use a variety of low-carbon heating technologies. The transition toward low-carbon heating technologies necessitates a complete restructuring of the heating system, with significant associated material requirements. However, little research has been done into the quantity and environmental impact of the required materials for this system change. We analyzed the material demand and the environmental impact of the transition toward low-carbon heating in the Netherlands across three scenarios based on the local availability and capacity for sources of low-carbon heat. A wide range of materials are included, covering aggregates, construction materials, metals, plastics, and critical materials. We find that while the Dutch policy goal of reducing GHG emissions by 90% before 2050 can be achieved if only direct emissions from the heating system are considered, this is no longer the case when the cradle-to-gate emissions from the additional materials, especially insulation materials, are taken into account. The implementation of these technologies will require 59–63 megatons of materials in the period of 2021–2050, leading to a maximum reduction of 62%.Industrial Ecolog

Voorraden in de maatschappij: de grondstoffenbasis voor een circulaire economie - deel III: met case studies op gebied van het gassysteem, de spoorinfrastructuur en consumentengoederen

Industrial Ecolog

Textbook outcome as a composite outcome measure in non-small-cell lung cancer surgery

OBJECTIVES: Quality assessment is an important element in providing surgical cancer care. The main objective of this study was to develop a new composite measure 'textbook outcome', to evaluate and improve quality of surgical care for patients undergoing a resection for non-small-cell lung cancer (NSCLC).METHODS: All patients undergoing an anatomical resection for NSCLC from 2012 to 2016 registered in the nationwide Dutch Lung Cancer Audit were included in an analysis to assess usefulness of a composite measure as a quality indicator. Based on expert opinion, textbook outcome was defined as having a complete resection (negative resection margins and sufficient lymph node dissection), plus no 30-day or in-hospital mortality, no reintervention in 30days, no readmission to the intensive care unit, no prolonged hospital stay (<14days), no hospital readmission after discharge and no major complications. The percentage of patients with a textbook outcome was calculated per hospital. Between-hospital variation in textbook outcome was analysed using case-mix adjustment models.RESULTS: In total, 5513 patients were included in this study. Textbook outcome was achieved in 26.4% of patients. Insufficient lymph node dissection had the most substantial effect on not realizing textbook outcome. If 'sufficient lymph node dissection' was not included as a criterion, textbook outcome would be 60.7%. Case-mix adjusted textbook outcome proportions per hospitals varied between 13.2% and 37.7%.CONCLUSIONS: In contrast to focusing on a single aspect, the composite measure textbook outcome provides insight into comprehensive performance in NSCLC surgery. It can be used to evaluate both individual hospitals and national performance and provides the opportunity to give benchmarked feedback to thoracic surgeons.Thoracic Surger

Expert consensus recommendations on the cardiogenetic care for patients with thoracic aortic disease and their first-degree

Background: Thoracic aortic aneurysm (TAA) is a potentially life-threatening disorder with a strong genetic component. The number of genes implicated in TAA has increased exponentially over the last decade. Approximately 20% of patients with TAA have a positive family history. As most TAA remain asymptomatic for a long time, screening of at risk relatives is warranted to prevent complications. Existing international guidelines lack detailed instructions regarding genetic evaluation and family screening of TAA patients. We aimed to develop a consensus document to provide medical guidance for all health care professionals involved in the recognition, diagnosis and treatment of patients with thoracic aortic disease and their relatives. Methods: A multidisciplinary panel of experts including cardiologists, cardiothoracic surgeons, clinical geneticists and general practitioners, convened to review and discuss the current literature, guidelines and clinical practice on genetic testing and family screening in TAA. Results: There is a lack of high-quality evidence in the literature. This consensus statement, based on the available literature and expert opinions, summarizes our recommendations in order to standardize and optimize the cardiogenetic care for patients and families with thoracic aortic disease. In particular, we provide criteria to identify those patients most likely to have a genetic predisposition, and discuss the preferred modality and frequency of screening in their relatives. Conclusions: Age, family history, aortic size and syndromic features determine who is advised to have genetic testing as well as screening of first-degree relatives. There is a need for more prospective multicenter studies to optimize current recommendations

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo