Grootschalige concentratie- en depositiekaarten Nederland : Rapportage 2014

Nieuwe concentratie- en depositiekaarten voor NSL en PAS Het RIVM heeft kaarten opgesteld waarop staat aangegeven wat in 2013 in Nederland de concentraties in de lucht waren van onder andere stikstofdioxide en fijn stof. Ook is op een kaart aangegeven in welke mate stikstof op de bodem neerslaat. Daarnaast zijn toekomstberekeningen voor deze stoffen gemaakt voor de periode 2015- 2030. De kaarten worden gebruikt voor de monitoring van het Nationaal Samenwerkingsprogramma Luchtkwaliteit (NSL) en de Programmatische Aanpak Stikstof (PAS). Hiermee worden onder andere de effecten van ruimtelijke plannen getoetst Stikstofdioxideconcentraties voor 2015 veelal lager De gemeten concentraties stikstofdioxide waren in 2013 lager dan in 2012. De concentraties die voor 2015 zijn berekend, zijn op de meeste locaties lager dan vorig jaar was geraamd. Toch blijven er een aantal probleemgebieden bestaan waarin de verwachte concentraties hoger zijn dan vorig jaar geraamd, vooral in de regio's Rotterdam en Den Haag. Wat de verwachte overschrijdingen van de normen in 2015 betreft, zal dat in Amsterdam en Utrecht op minder locaties aan de orde zijn dan eerder was ingeschat, en in Rotterdam op meer locaties Drie oorzaken voor deze aangepaste verwachting zijn het belangrijkst. Als eerste is bij de ramingen een correctie aangebracht voor systematische verschillen tussen gemeten en berekende stikstofdioxideconcentraties. Ten tweede stoten de nieuwste modellen vrachtauto's minder stikstofoxiden uit dan eerder was ingeschat. Ten derde zijn effecten meegenomen van het SER-energieakkoord uit 2013. Hierin zijn afspraken gemaakt om energie te besparen bij huishoudens, industrie en landbouw en het aandeel alternatieve energiebronnen als wind- en zonne-energie te vergroten Roetconcentraties dalen naar verwachting verder Steeds meer dieselauto's hebben een filter, waarmee roet effectief wordt afgevangen. Op basis van het huidige beleid wordt geschat dat de roetconcentratie de komende jaren verder daalt, en in 2020 bijna zal zijn gehalveerd ten opzicht van het huidige niveau Daling stikstofdepositie onveranderd De neerslag van stikstof op de bodem in Nederland daalt naar verwachting de komende jaren in ongeveer dezelfde mate als vorig jaar was geraamd. Een dalende stikstofdepositie is een voorwaarde voor natuurbehoudNew maps of concentrations and depositions for NSL and PAS In this report, the National Institute for Public Health and the Environment (RIVM) presents the latest maps of air concentrations in the Netherlands for several substances, including nitrogen dioxide and particulate matter for 2013. It also presents the maps for the deposition of nitrogen compounds to the soil for that year. Calculations for the future (2015-2030) have also been made. The maps are being used in the national air quality collaboration programme (NSL) and for the programmatic approach to nitrogen (PAS) for monitoring new spatial planning projects Nitrogen dioxide concentrations mostly lower for 2015 The measured concentrations of nitrogen dioxide were in 2013 lower than in 2012. Concentrations calculated for 2015 are at most locations below last year's estimates. Yet, there remain a number of areas where the expected concentrations are higher than last year's estimates, especially in the vicinity of Rotterdam and The Hague. The limit value for the nitrogen dioxide concentration will probably be exceeded in fewer locations in Amsterdam and Utrecht than was estimated earlier and in more locations in Rotterdam in 2015 There are three main reasons for these adjusted expectations of future concentrations. First, a correction is applied to projections of nitrogen dioxide concentrations for systematic differences between measured and calculated concentrations. Second, the latest truck models emit less nitrogen oxides than was previously expected. Third, the effects of the SER energy agreement from 2013 have been taken into account. Arrangements have been made in the agreement to save energy in households, industry and agriculture, and to increase the share of alternative energy sources, such as, wind and solar energy Soot concentrations are expected to decrease further More and more diesel cars have a filter, which is effective in capturing soot. It is expected that, based on the current policies, the soot concentrations will continue to decrease in the coming years and will be reduced by almost 50 percent by 2020 compared to current levels Decrease in nitrogen deposition unchanged The deposition of nitrogen to the soil in the Netherlands is expected to decrease in the coming years by approximately the same amount as was estimated last year. A reduction in nitrogen deposition is a prerequisite for nature conservationMinisterie van I&

Assessing fitness-to-practice of overseas-trained health practitioners by Australian registration & accreditation bodies

Assessment of fitness-to-practice of health professionals trained overseas and who wish to practice in Australia is undertaken by a range of organisations. These organisations conduct assessments using a range of methods. However there is very little published about how these organisations conduct their assessments. The purpose of the current paper is to investigate the methods of assessment used by these organisations and the issues associated with conducting these assessments

Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial

BACKGROUND: Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. METHODS: 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with ≤ 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. RESULTS: At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P < 0.01) months and significantly greater decrease in days with missed activities at one (85% vs. 15%, P = 0.02) and two (95% vs. 77%. P = 0.05) months. During the two months of follow-up, more children who had learned guided imagery met the threshold of ≤ 4 day of pain each month and no missed activities (RR = 7.3, 95%CI [1.1,48.6]) than children who learned only the breathing exercises. CONCLUSION: The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Drogedepositiemetingen van ammoniak in Natura 2000-gebied Bargerveen

De gemiddelde droge depositie van ammoniak in Natura 2000-gebied Bargerveen (Drenthe) ligt per jaar tussen 7 en 10 kilo stikstof (N) per hectare. Dit blijkt uit metingen van het RIVM, die tussen september 2011 en september 2012 zijn uitgevoerd. Het is de eerste keer dat de droge depositie van ammoniak gerapporteerd wordt op basis van metingen met de zogeheten COTAG-opstelling (Conditional Time Averaged Gradient). Droge depositie is een proces waarbij ammoniak vanuit de lucht neerslaat, zonder dat daar neerslag aan te pas komt. Natura 2000 is een Europees netwerk van natuurgebieden waar planten en dieren worden beschermd. De metingen zijn in opdracht van het ministerie van Economische Zaken uitgevoerd in het kader van de aanpak van de hoge stikstofdepositie op de Nederlandse natuur (Programmatische Aanpak Stikstof, PAS). Door een overmaat aan stikstof vermest de natuur, waardoor het aantal soorten dieren en planten afneemt. In Nederlandse natuurgebieden draagt ammoniak, dat voornamelijk afkomstig is uit de landbouw, in belangrijke mate bij aan de totale stikstofdepositie. De totale stikstofdepositie op Natura 2000 gebieden wordt met modelberekeningen bepaald. Meetgegevens zijn belangrijk om de berekeningen te toetsen. De COTAG-opstelling is in het Verenigd Koninkrijk ontwikkeld en de afgelopen jaren binnen een Europees onderzoeksproject (NitroEurope) in meerdere landen gebruikt. Het meet de ammoniakconcentratie op twee hoogtes, waarna deze gegevens worden gecombineerd met meteorologische gegevens over windsnelheid en temperatuur om de droge depositie te bepalen. Meteorologische omstandigheden zijn namelijk van invloed op de mate waarin de concentraties tussen de twee hoogte 'uitwisselen'. Op basis van de resultaten van dit eerste meetjaar lijkt de COTAGmeetopstelling geschikt om de droge ammoniakdepositie in Nederland te meten. De resultaten komen onder andere overeen met de metingen van de ammoniakconcentraties die vanuit het Meetnet Ammoniak in Natuurgebieden in Bargerveen zijn uitgevoerd. Dit meetnet, opgezet in 2005, meet de concentraties ammoniak in een zestigtal natuurgebieden in Nederland.The average dry deposition of ammonia in Natura 2000 area Bargerveen (in the province of Drenthe) is estimated to be 7-10 kilogram nitrogen (N) per hectare per year. This estimate is based on measurements by the RIVM, conducted for the first time with the so called COTAG (Conditional Time Averaged Gradient) instrument between September 2011 and September 2012. Dry deposition is a process in which ammonia is deposited on the ground and vegetation without the aid of rain. Natura 2000 is a European network of nature areas in which vegetation and animals are being protected. The measurements are conducted on behalf of the Ministry of Economic Affairs owing to high nitrogen deposition on Dutch nature areas (Integrated Approach to Nitrogen, PAS). Excessive nitrogen deposition leads to eutrophication which adversely affects biodiversity. In Dutch nature areas ammonia, which is mainly emitted by agricultural activities, has a large contribution to the total nitrogen deposition. Total nitrogen deposition estimates for Natura 2000 areas are based on model calculations. Measurements are important in order to check the computations. The COTAG instrument was developed in the United Kingdom and was used in several countries within an European research project (NitroEurope) in the past years. The instrument measures ammonia concentrations at two heights; after combining these data with measurements of air temperature and wind velocity the dry deposition can be determined. Meteorological conditions namely influence the extent to which concentrations at two different heights mix. Based on the first year of results, the COTAG appears to be suitable for measuring dry deposition of ammonia in the Netherlands. Among others the measurements match with ammonia concentration measurements obtained in Bargerveen within the Monitoring network Ammonia in Nature areas (MAN). This monitoring network, established in 2005, currently measures in sixty-odd nature areas in the Netherlands.Ministerie van E