Liever inleiden dan afwachten bij aterme zwangerschapshypertensie en milde preeclampsie: HYPITAT-studie

OBJECTIVE: To investigate what would benefit women with mild full-term pregnancy-related hypertension most: induction of labour or expectant monitoring, from the perspective of clinical effectiveness, maternal quality of life, and costs. DESIGN: Randomised clinical trial. Trial registration number ISRCTN08132825. METHODS: We undertook a multicentre randomised controlled trial in 38 hospitals in the Netherlands between October 2005 and March 2008. We enrolled patients with a singleton pregnancy in cephalic presentation at 36-41 weeks' gestation, who had gestational hypertension or mild preeclampsia. Participants were randomly allocated to receive either induction of labour or expectant monitoring. The primary outcome was a composite measure of poor maternal outcome, defined as maternal mortality, maternal morbidity (eclampsia, 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome, pulmonary oedema, thrombo-embolic disease and abruptio placentae), progression to severe hypertension or proteinuria, and major postpartum haemorrhage. Secondary outcomes were mode of delivery, neonatal outcome, maternal quality of life and costs. Analysis was by intention to treat. RESULTS: A total of 756 patients were allocated to receive induction of labour (n = 377 patients) or expectant monitoring (n = 379). No cases of maternal or neonatal death or eclampsia were recorded. Development of poor maternal outcome was significantly lower in the induction of labour group (117 women) than the expectant monitoring group (166 women) (31% versus 44%; relative risk 0.71 (95% CI: 0.59-0.86); p < 0.001). The caesarean section rate was lower among women in the induction of labour group (n = 54) compared to women in the expectant monitoring group (n = 72) (14% versus 19%; relative risk 0.75 (95% CI: 0.55-1.04)< p = 0.085). Neonatal outcomes and quality of life were comparable between both groups. Induction of labour is a cost saving strategy (difference euro 831). CONCLUSION: For women with full-term gestational hypertension and pre-eclampsia, induction of labour is associated with improved maternal outcome and lower costs, without the additional risk of a caesarean section being necessary

Interorganisational design; a new approach to team design in architecture and urban planning

Architectur

Computational & Methodological studies for interorganisational design in architecture, building and urban development

Architectur

An Urban Decision Room Based on Mathematical Optimisation - A pilot study supporting complex urban decision questions

Architectur

Sustainability and urban density a decision based design approach

This paper concerns the definition, construction and application of a decision based design model which able the integration of the allocation of a variety of urban land uses with the distribution of different urban densities, in particular of residential urban areas. Urban planning is, among others things about the spatial distribution of human activities and their physical facilities like buildings, roads, green areas etc. in amount, place and time over a well-defined area. Today, sustainable urban development and sustainability in urban areas are important issues in urban planning. The aspects related to these issues have to be taken in account when developing urban areas. One of these aspects is urban density. Nowadays, it is generally assumed (and accepted) that urban density is related to sustainability. New urban planning approaches, loosely based around new urbanism, are successfully reducing environmental impacts by altering the built environment to create and preserve sustainable cities which support sustainable transport. Residents in compact urban neighborhoods drive fewer miles, and have significantly lower environmental impacts across a range of measures, compared with those living in sprawling suburbs.Real Estate and HousingArchitectur

Measuring thermal conductivity in freezing and thawing soil using the soil temperature response to heating

The thermal conductivity of the thin seasonally freezing and thawing soil layer in permafrost landscapes exerts considerable control over the sensitivity of the permafrost to energy and mass exchanges at the surface. At the same time, the thermal conductivity is sensitive to the state of the soil, varying, for example, by up to two orders of magnitude with varying water contents. In situ measurement techniques perturb the soil thermally and are affected by changes in soil composition, for example through variations in thermal contact resistance between sensor and soil. The design of a sensor for measuring the temperature of the soil rather than the axial heating wire temperature has consequences for the modeling of heat flow. We introduce an approximation of heat flow from a heated cylinder with thermal contact resistance between the cylinder and the surrounding medium. This approximation is compared to the standard line source approximation, and both are applied to data measured over a one-year period in northern Alaska. Comparisons of thermal conductivity values determined numerically using the line source solution, line source approximation and the analytical form of the heated cylinder model fall within 10% of accepted values, except for measurements made in pure ice, for which all methods of calculation under-predicted the thermal conductivity. Field data collected from a complete freeze¿thaw cycle in silty clay show a seasonally bimodal apparent thermal conductivity, with a sharp transition between frozen and thawed values during thaw, but a three-month transition period during freezing. The use of soil composition data to account for changes in heat flow due to the effect of latent heat during phase change results in a relationship between soil thermal conductivity and temperature

Ontwerp- en planningmethodologie I: Voor stedebouwkunde en ruimtelijke planning. Deel 1: De omgeving van methoden, Deel 2: Doelen en middelen

Architectur