No association between glucocorticoid receptor polymorphisms and long-term respiratory outcome after very preterm birth

Developmen

Gender differences in respiratory symptoms in 19-year-old adults born preterm

Objective: To study the prevalence of respiratory and atopic symptoms in (young) adults born prematurely, differences between those who did and did not develop Bronchopulmonary Disease (BPD) at neonatal age and differences in respiratory health between males and females. Methods: Design: Prospective cohort study. Setting: Nation wide follow-up study, the Netherlands. Participants: 690 adults (19 year old) born with a gestational age below 32 completed weeks and/or with a birth weight less than 1500g. Controls were Dutch participants of the European Community Respiratory Health Survey (ECRHS). Main outcome measures: Presence of wheeze, shortness of breath, asthma, hay fever and eczema using the ECRHS-questionnaire

Principle and design of a mobile arm support for people with muscular weakness

This article describes the development of a mobile arm support for people with muscular diseases. The arm support is spring-balanced, with special attention on reduction of operating effort (high balancing quality and low friction), functionality (large range of motion), and aesthetics (inconspicuous design). The spring settings can be adjusted for wearing heavier clothing or picking up an object, a function that can also be used for moving up or down. The device levels itself automatically to compensate for uneven floors, a function that can be overruled to assist forward/backward motion of the arm. Thus, the balancer can compensate for the weight of the arm and be adjusted to generate force to a limited (safe) extent. The principle and design of the mechanism are presented and preliminary field trial results are given. Two users report on 6 months of continuous use of the arm support in their home and social environments.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin

Assessment of controversial pediatric asthma management options using GRADE

OBJECTIVES: To develop explicit and transparent recommendations on controversial asthma management issues in children and to illustrate the usefulness of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in rating the quality of evidence and strength of recommendations. METHODS: Health care questions were formulated for 3 controversies in clinical practice: what is the most effective treatment in asthma not under control with standard-dose inhaled corticosteroids (ICS; step 3), the use of leukotriene receptor antagonist for viral wheeze, and the role of extra fine particle aerosols. GRADE was used to rate the quality of evidence and strength of recommendations after performing systematic literature searches. We provide evidence profiles and considerations about benefit and harm, preferences and values, and resource use, all of which played a role in formulating final recommendations. RESULTS: By applying GRADE and focusing on outcomes that are important to patients and explicit other considerations, our recommendations differ from those in other international guidelines. We prefer to double the dose of ICS instead of adding a long-acting β-agonist in step 3; ICS instead of leukotriene receptor antagonist are the first choice in preschool wheeze, and extra fine particle ICS formulations are not first-line treatment in children with asthma. Recommendations are weak and based on low-quality evidence for critical outcomes. CONCLUSIONS: W

Accelerating geothermal development with a play-based portfolio approach

Over the past decade in the Netherlands, most operators have only developed a single doublet. The learning effect from these single events is suboptimal, and operators have only been capable of developing doublets in areas with relatively low exploration risk. This ‘stand-alone’ approach can be significantly improved by a collective approach to derisk regions with similar subsurface characteristics. Such a play-based portfolio approach, which is common in the oil and gas industry, can help to accelerate the development of the geothermal industry through unlocking resource potential in areas marked by high upfront geological risk, effectively helping reduce costs for the development. The basis of the methodology is to deploy new information to the play portfolio by trading off with the risk of the first wells, resulting in a strong geological risk reduction. The added value of the portfolio approach is demonstrated for the Netherlands in this paper through a comparison with a ‘stand-alone’ development. In the stand-alone approach, each new project will be equally risky, and therefore relatively unprofitable. In the case of a portfolio approach, all experience about the play is used optimally for derisking. In case of success, subsequent projects will have a higher chance of being successful, due to the experience gained in previous projects. Even if a project fails, this may help in increasing the probability of success for subsequent projects. For plays that are initially considered too risky for the market to start developing, the value of information (VoI) of a play-based portfolio approach will help by derisking the play to such an extent that it becomes attractive for the market to develop, even at high initial risk. It can be demonstrated for several geothermal plays in the Netherlands that by adopting the portfolio approach, the probability of a play being developed becomes higher, the number of successfully developed projects increases and the average profitability of the project will also be higher. Five more advantages are: (1) continuous improvement by integrated project development, (2) cost reduction through synergy, efficiency and standardisation, (3) optimisation of the surface heat demand and infrastructure, (4) the possibility of structural research and development (R&D) and innovation, and (5) financing advantages. The advantages reinforce each other. A preliminary estimate of the geothermal potential of the Netherlands adopting the portfolio approach is between 90 and 275 Petajoules (PJ). For about 350 doublets being developed, producing about 70 PJ, the value of the advantage of the play-based portfolio approach is €2 billion for the three main plays: Rotliegend, Triassic and Jurassic/Cretaceous. The learning effects of synergy, efficiency and standardisation are expected to be significant

Accelerating geothermal development with a play-based portfolio approach

Over the past decade in the Netherlands, most operators have only developed a single doublet. The learning effect from these single events is suboptimal, and operators have only been capable of developing doublets in areas with relatively low exploration risk. This ‘stand-alone’ approach can be significantly improved by a collective approach to derisk regions with similar subsurface characteristics. Such a play-based portfolio approach, which is common in the oil and gas industry, can help to accelerate the development of the geothermal industry through unlocking resource potential in areas marked by high upfront geological risk, effectively helping reduce costs for the development. The basis of the methodology is to deploy new information to the play portfolio by trading off with the risk of the first wells, resulting in a strong geological risk reduction. The added value of the portfolio approach is demonstrated for the Netherlands in this paper through a comparison with a ‘stand-alone’ development. In the stand-alone approach, each new project will be equally risky, and therefore relatively unprofitable. In the case of a portfolio approach, all experience about the play is used optimally for derisking. In case of success, subsequent projects will have a higher chance of being successful, due to the experience gained in previous projects. Even if a project fails, this may help in increasing the probability of success for subsequent projects. For plays that are initially considered too risky for the market to start developing, the value of information (VoI) of a play-based portfolio approach will help by derisking the play to such an extent that it becomes attractive for the market to develop, even at high initial risk. It can be demonstrated for several geothermal plays in the Netherlands that by adopting the portfolio approach, the probability of a play being developed becomes higher, the number of successfully developed projects increases and the average profitability of the project will also be higher. Five more advantages are: (1) continuous improvement by integrated project development, (2) cost reduction through synergy, efficiency and standardisation, (3) optimisation of the surface heat demand and infrastructure, (4) the possibility of structural research and development (R&D) and innovation, and (5) financing advantages. The advantages reinforce each other. A preliminary estimate of the geothermal potential of the Netherlands adopting the portfolio approach is between 90 and 275 Petajoules (PJ). For about 350 doublets being developed, producing about 70 PJ, the value of the advantage of the play-based portfolio approach is €2 billion for the three main plays: Rotliegend, Triassic and Jurassic/Cretaceous. The learning effects of synergy, efficiency and standardisation are expected to be significant

Borrelia burgdorferi sensu lato seroconversion after intravenous immunoglobulin treatment: A cohort study

Objective: Intravenous immunoglobulin (IVIg) consists of pooled donor immunoglobulins (IgG), possibly including anti-Borrelia burgdorferi (Bbsl) antibodies. Apparent IVIg-related Bbsl seroconversion could lead to incorrect diagnosis of Lyme borreliosis. This cohort study was designed to determine how often IVIg treatment leads to apparent Bbsl seroconversion and whether antibodies disappear post-treatment. Methods: Sera from chronic inflammatory demyelinating polyneuropathy (CIDP) and myositis patients were analyzed, drawn pre-treatment and 6–12 weeks after the start of IVIg. In patients with apparent seroconversion, follow-up samples after treatment withdrawal were analyzed, if available. Patients treated with corticosteroids were included as controls. A two-tier protocol was used for serological testing consisting of the C6 Lyme ELISA (Oxford Immunotec) and confirmation by immunoglobulin M (IgM) and immunoglobulin G (IgG) immunoblot (Mikrogen®). Results: We included 61 patients: 51 patients were treated with IVIg and 10 with dexamethasone. Of the patients treated with IVIg, 42 had CIDP (82%) and were treated with Nanogam® (Sanquin Plasma Products). Nine patients had myositis (18%) and were treated with Privigen® (CSL Behring). Anti-Bbsl IgG seroprevalence pre-treatment was 3% (2/61). Apparent seroconversion during IVIg treatment occurred in 39% (20/51) of patients, all treated with Nanogam. Post-treatment seroreversion occurred in 92% (12/13) of patients with available follow-up samples; in 78% (7/9) seroreversion was observed within 3 months. Conclusions: Transient presence of anti-Bbsl IgG antibodies after IVIg is regularly observed. This effect appears to be dependent on the IVIg brand, probably reflecting variation in Bbsl exposure of plasma donors. Lyme borreliosis serological testing during, and weeks to months after, IVIg is therefore of limited utility