Ook reuma kan ondraaglijk zijn:Euthaniasie reële optie bij patiënten met uitzichtlose reumatoïde artritis

Reumatoïde artritis is weliswaar niet op korte termijn dodelijk, maar kan wel ondraaglijk en uitzichtloos zijn. Voor zulke patiënten is euthanasie soms de enige uitweg, betogen reumatoloog Evert-Jan ter Borg en collega’s aan de hand van twee praktijkvoorbeelden

A digital twin of the terrestrial water cycle : a glimpse into the future through high-resolution Earth observations

Climate change is profoundly affecting the global water cycle, increasing the likelihood and severity of extreme water-related events. Better decision-support systems are vital to accurately predict and monitor water-related environmental disasters and optimally manage water resources. These must integrate advances in remote sensing, in situ, and citizen observations with high-resolution Earth system modeling, artificial intelligence (AI), information and communication technologies, and high-performance computing. Digital Twin Earth (DTE) models are a ground-breaking solution offering digital replicas to monitor and simulate Earth processes with unprecedented spatiotemporal resolution. Advances in Earth observation (EO) satellite technology are pivotal, and here we provide a roadmap for the exploitation of these methods in a DTE for hydrology. The 4-dimensional DTE Hydrology datacube now fuses high-resolution EO data and advanced modeling of soil moisture, precipitation, evaporation, and river discharge, and here we report the latest validation data in the Mediterranean Basin. This system can now be explored to forecast flooding and landslides and to manage irrigation for precision agriculture. Large-scale implementation of such methods will require further advances to assess high-resolution products across different regions and climates; create and integrate compatible multidimensional datacubes, EO data retrieval algorithms, and models that are suitable across multiple scales; manage uncertainty both in EO data and models; enhance computational capacity via an interoperable, cloud-based processing environment embodying open data principles; and harness AI/machine learning. We outline how various planned satellite missions will further facilitate a DTE for hydrology toward global benefit if the scientific and technological challenges we identify are addressed

Impact of Stopping Tumor Necrosis Factor Inhibitors on Rheumatoid Arthritis Patients' Burden of Disease

Item does not contain fulltextOBJECTIVE: To determine the impact of stopping tumor necrosis factor inhibitor (TNFi) treatment on patient-reported outcomes (PROs) of physical and mental health status, health utility, pain, disability, and fatigue in patients with established rheumatoid arthritis (RA). METHODS: In the pragmatic, 12-month POET trial, 817 RA patients with >/=6 months of remission or stable low disease activity were randomized 2:1 to stopping or continuing TNFi. In case of flare, TNFi was restarted at the discretion of the rheumatologist. PROs were assessed every 3 months. RESULTS: TNFi was restarted within 12 months in 252 of 531 patients (47.5%) in the stop group. At 3 months, mean PRO scores were significantly worse in the stop group, and a larger proportion of patients experienced a minimum clinically important difference (MCID) on all PROs. Effect sizes (ES) were strongest for health utility (ES -0.24) and pain (ES -0.30). Mean scores improved again after this point, but disability scores remained significantly different at 12 months. After 12 months, the relative risk of experiencing an MCID ranged from 1.16 for mental health status to 1.58 for fatigue. Mean PRO scores for patients restarting TNFi within 6 months were no longer significantly different from those that did not restart TNFi at 12 months. CONCLUSION: Stopping TNFi had a significant negative short-term impact on a broad range of PROs. Long-term negative consequences appeared to be limited, and outcomes in patients needing to restart TNFi within the first 6 months tended to be restored at 12 months