De statuur van Jan van Riebeeck en de betekenis van de volksplanting.

In 1927 heeft wijlen de Leidse professor Knappert een aantal, aan Joan van Riebeeck’s Dagverhaal ontleende mededelingen in dezer voege samengevat: „het is van Riebeeck gegaan als vele groten van ons geslachl; hij heeft ervaren, dat . . . deucht met ondeucht geloont wert.” Noch in Amsterdam noch in Batavia hadden de bureaucraten veel met de Kaap op

Driving Pressure Is Associated With Outcome in Pediatric Acute Respiratory Failure

OBJECTIVES: Driving pressure (ratio of tidal volume over respiratory system compliance) is associated with mortality in acute respiratory distress syndrome. We sought to evaluate if such association could be identified in critically ill children. DESIGN: We studied the association between driving pressure on day 1 of mechanical ventilation and ventilator-free days at day 28 through secondary analyses of prospectively collected physiology data. SETTING: Medical-surgical university hospital PICU. PATIENTS: Children younger than 18 years (stratified by Pediatric Mechanical Ventilation Consensus Conference clinical phenotype definitions) without evidence of spontaneous respiration. INTERVENTIONS: Inspiratory hold maneuvers. MEASUREMENTS AND MAIN RESULTS: Data of 222 patients with median age 11 months (2-51 mo) were analyzed. Sixty-five patients (29.3%) met Pediatric Mechanical Ventilation Consensus Conference criteria for restrictive and 78 patients (35.1%) for mixed lung disease, and 10.4% of all patients had acute respiratory distress syndrome. Driving pressure calculated by the ratio of tidal volume over respiratory system compliance for the whole cohort was 16 cm H2O (12-21 cm H2O) and correlated with the static airway pressure gradient (plateau pressure minus positive end-expiratory pressure) (Spearman correlation coefficient = 0.797; p < 0.001). Bland-Altman analysis showed that the dynamic pressure gradient (peak inspiratory pressure minus positive end-expiratory pressure) overestimated driving pressure (levels of agreement -2.295 to 7.268). Rematching the cohort through a double stratification procedure (obtaining subgroups of patients with matched mean levels for one variable but different mean levels for another ranking variable) showed a reduction in ventilator-free days at day 28 with increasing driving pressure in patients ventilated for a direct pulmonary indication. Competing risk regression analysis showed that increasing driving pressure remained independently associated with increased time to extubation (p < 0.001) after adjusting for Pediatric Risk of Mortality III 24-hour score, presence of direct pulmonary indication jury, and oxygenation index. CONCLUSIONS: Higher driving pressure was independently associated with increased time to extubation in mechanically ventilated children. Dynamic assessments of driving pressure should be cautiously interpreted

Energy transmission in mechanically ventilated children:a translational study

Background: Recurrent delivery of tidal mechanical energy (ME) inflicts ventilator-induced lung injury (VILI) when stress and strain exceed the limits of tissue tolerance. Mechanical power (MP) is the mathematical description of the ME delivered to the respiratory system over time. It is unknown how ME relates to underlying lung pathology and outcome in mechanically ventilated children. We therefore tested the hypothesis that ME per breath with tidal volume (Vt) normalized to bodyweight correlates with underlying lung pathology and to study the effect of resistance on the ME dissipated to the lung. Methods: We analyzed routinely collected demographic, physiological, and laboratory data from deeply sedated and/or paralyzed children < 18 years with and without lung injury. Patients were stratified into respiratory system mechanic subgroups according to the Pediatric Mechanical Ventilation Consensus Conference (PEMVECC) definition. The association between MP, ME, lung pathology, and duration of mechanical ventilation as a primary outcome measure was analyzed adjusting for confounding variables and effect modifiers. The effect of endotracheal tube diameter (ETT) and airway resistance on energy dissipation to the lung was analyzed in a bench model with different lung compliance settings. Results: Data of 312 patients with a median age of 7.8 (1.7-44.2) months was analyzed. Age (p < 0.001), RR p < 0.001), and Vt < 0.001) were independently associated with MPrs. ME but not MP correlated significantly (p < 0.001) better with lung pathology. Competing risk regression analysis adjusting for PRISM III 24 h score and PEMVECC stratification showed that ME on day 1 or day 2 of MV but not MP was independently associated with the duration of mechanical ventilation. About 33% of all energy generated by the ventilator was transferred to the lung and highly dependent on lung compliance and airway resistance but not on endotracheal tube size (ETT) during pressure control (PC) ventilation. Conclusions: ME better related to underlying lung pathology and patient outcome than MP. The delivery of generated energy to the lung was not dependent on ETT size during PC ventilation. Further studies are needed to identify injurious MErs thresholds in ventilated children

A Letter of A. C. V. R. to The Brethren Published in De Grondwet Within an Article

A letter of A.C.V.R. to the Brethren- about raising funds for the academy building and promoting the academy. He is using the call from the Pella congregation as an instrument to gain support for the academy. The letter is part of the article written by Gerrit Van Schelven and published in De Grondwet on August 6, 1912, under the title, Van Vleck Hall

Transmission line models of planar slot antennas

We propose a systematic approach to describe planar slot antennas, embedded in generic stratified media. An equivalent transmission line model for the slot is proposed, based on a spectral domain analysis. First, we introduce a method of moments solution to model semi-infinite slots, fed by a deltagap excitation. The solution entails only two basis functions, one located at the feed and the other at the termination. The latter basis function is chosen to properly account for the field diffractive behavior at the antenna end point. An approximate circuit model is then introduced, which describes the main mode propagating along the slot as an equivalent transmission line. Lumped impedances are extracted to accurately describe the source and the end point. This procedure can be used to derive the input impedance of planar antennas with arbitrary length in generic layered media or the interaction between multiple feeds within the same slot

Equivalent circuit models of finite slot antennas

We propose a systematic approach to describe pla- nar slot antennas, embedded in generic stratified media. An equivalent transmission line model for the slot is proposed, based on a spectral domain analysis. First, we introduce a method of moments solution to model semi-infinite or finite slots, fed by a delta-gap excitation. The solution entails only two basis functions, one located at the feed and the other at the terminations. The latter basis function is chosen to properly account for the field diffractive behavior at the antenna end points. An approximate circuit model is then introduced, which describes the main mode propagating along the slot as an equivalent transmission line. Lumped impedances are extracted to accurately describe the source and the end points: the reactances account for the reactive nature of the feed and the termination, while the resistances represent the radiated space waves, emerging from both the feed and the end points. This procedure can be used to derive the input impedance of planar antennas with arbitrary length in generic layered media or the interaction between multiple feeds within the same slot

Equivalent Circuit Models of Finite Slot Antennas

We present a systematic approach to describe planar slot antennas embedded in generic stratified media. An equivalent transmission line model for the slot is proposed, based on a spectral domain analysis. First, we introduce a method of moments solution to model semiinfinite or finite slots, fed by a delta-gap excitation. The solution entails only two basis functions, one located at the feed and the other at the termination. The latter basis function is chosen to properly account for the field diffractive behavior at the antenna end points. An approximate circuit model is then introduced, which describes the main mode propagating along the slot as an equivalent transmission line. Lumped impedances are extracted to accurately describe the source and the end points: The reactances account for the reactive nature of the feed and the termination, while the resistances represent the radiated space waves, emerging from both the feed and the end points. This procedure can be used to derive the input impedance of planar slot antennas with arbitrary length in generic layered media or the interaction between multiple feeds within the same slot.</p

Pitfalls in the analysis of electrogastrographic recordings

Electrogastrography (EGG) is a noninvasive method to study gastric myoelectrical activity in humans. Because frequency characteristics are the most reliable parameters and visual analysis of the EGG recordings is notoriously difficult, automated frequency analysis, especially running spectrum analysis, is often used. However, EGG frequency spectra can be misinterpreted easily. Movement artifacts and noise from various sources can result in abnormal frequency spectra with significant power in the low-frequency and high-frequency range, or even make the EGG completely uninterpretable. Signals that differ from a sinusoid waveform have harmonics in the high-frequency range of the spectrum and may be interpreted as abnormal. Visual inspection of raw signals and frequency spectra remains essential in the analysis of EGG signals. The value of computerized analysis should not be overrated. EGG is an important research tool, but a clinical role still needs to be establishe