Do green roofs cool the air?

AbstractRapid urbanization and an increasing number and duration of heat waves poses a need to mitigate extremely high temperatures. One of the repeatedly suggested measures to moderate the so called urban heat island are green roofs. This study investigates several extensive sedum-covered green roofs in Utrecht (NL) and their effect on air temperature right above the roof surface. The air temperature was measured 15 and 30 cm above the roof surface and also in the substrate. We showed that under well-watered conditions, the air above the green roof, compared to the white gravel roof, was colder at night and warmer during the day. This suggests that extensive sedum-covered green roofs might help decrease air temperatures at night, when the urban heat island is strongest, but possibly contribute to high daytime temperatures. The average 24 h effect of sedum-covered green roof was a 0.2 °C increase of air temperature 15 cm above the ground. During a dry year the examined green roof exhibited behavior similar to conventional white gravel roof even exhibited slight cooling effect in late afternoon. Interestingly, the pattern of soil temperature remained almost the same for both dry and well-prospering green roofs, colder during the day and warmer at night

Dynamic Simulation Modeling to Analyze the Impact of Whole Genome Sequencing National Implementation Scenarios in Lung cancer on Time-to-Treatment, Costs and Patient Demand

Background Although Whole Genome Sequencing (WGS) is increasingly proposed to unravel molecular origins of advanced cancers, it is less clear if and how WGS should be routinely offered in the health service. The objective of this study is to investigate how the cost per patient and time-to-treatment is affected if WGS were implemented in the national health system and how these outcomes differ among subgroups of patients with lung cancer. This first-ever study used health systems simulation modeling to analyze implementation scenarios ensuring sustainable access to cancer treatment.Methods A base case and three scenarios (varying stage of disease and hospitals offering WGS) the optimal placement of WGS in the diagnostic pathway was simulated using a dynamic simulation model. The model simulated lung cancer patients undergoing molecular diagnostic procedures in one or multiple hospitals. The model also included patient and healthcare provider heterogeneity as well as referral patterns of lung cancer (LC) patients using patient-level data obtained from the Netherlands Cancer Registry. Model outcomes were the time-to-treatment, total diagnostic cost, and the demand for WGS sequencing capacity including the expertise of a molecular tumor board.Results The time-to-treatment ranged between 20-46 days for all four scenarios considered. The cost of molecular diagnostic testing per patient ranged from €621 in the base case to €1930 in the scenario where all LC patients (stage I-IV) receive upfront WGS. Compared to the base case, upfront testing using WGS in all LC patients led to a 33% reduction in the time-to-treatment, a 210% increase in the cost per patient and a six-fold increase in total diagnostic costs.Conclusions This first-ever study investigating implementation scenario’s demonstrated that upfront WGS for all lung cancer patients can reduce the time to treatment yet at a higher cost. However, upfront WGS also reduces diagnostic pathway complexity, which may improve care planning and treatment efficiency. The model is versatile in its approach to study the impact of price discounts or the amount of actionable targets tested for and further analysis showed discounts on consumables up to 50% imply WGS would the preferred strategy

Treatment outcome of patients with recurrent glioblastoma multiforme:A retrospective multicenter analysis

Glioblastoma multiforme (GBM) universally recurs with dismal prognosis. We evaluated the efficacy of standard treatment strategies for patients with recurrent GBM (rGBM). From two centers in the Netherlands, 299 patients with rGBM after first-line treatment, diagnosed between 2005 and 2014, were retrospectively evaluated. Four different treatment strategies were defined: systemic treatment (SYST), re-irradiation (RT), re-resection followed by adjuvant treatment (SURG) and best supportive care (BSC). Median OS for all patients was 6.5 months, and median PFS (excluding patients receiving BSC) was 5.5 months. Older age, multifocal lesions and steroid use were significantly associated with a shorter survival. After correction for confounders, patients receiving SYST (34.8%) and SURG (18.7%) had a significantly longer survival than patients receiving BSC (39.5%), 7.3 and 11.0 versus 3.1 months, respectively [HR 0.46 (p &lt;0.001) and 0.36 (p &lt;0.001)]. Median survival for patients receiving RT (7.0%) was 9.2 months, but this was not significantly different from patients receiving BSC (p = 0.068). Patients receiving SURG compared to SYST had a longer PFS (9.0 vs. 4.3 months, respectively; p &lt;0.001), but no difference in OS was observed. After adjustments for confounders, patients with rGBM selected for treatment with SURG or SYST do survive significantly longer than patients who are selected for BSC based on clinical parameters. The value of reoperation versus systemic treatment strategies needs further investigation.</p

Clues For Genetic Anticipation In Multiple Endocrine Neoplasia Type 1

CONTEXT: Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant hereditary disease caused by the loss of function of the MEN1 gene, a tumor-suppressor gene that encodes the protein menin. It is characterized by the occurrence of primary hyperparathyroidism (pHPT), duodenopancreatic neuroendocrine tumors (dpNET), pituitary tumors (PIT), adrenal adenomas, and bronchopulmonary (bp-NET), thymic, and gastric neuroendocrine tumors. More insight into factors influencing the age-related penetrance of MEN1 manifestations could provide clues for more personalized screening programs. OBJECTIVE: To investigate whether genetic anticipation plays a role in the largest known MEN1 families in the Netherlands. METHODS: All Dutch MEN1 families with ≥ 10 affected members in ≥ 2 successive generations were identified. Age at detection of the different MEN1-related manifestations were compared among generations using regression analyses adjusted for competing risks. To correct for the beneficial effect of being under surveillance, manifestations occurring during surveillance were also separately compared. RESULTS: A total of 152 MEN1 patients from 10 families were included. A significantly decreased age at detection of pHPT, dpNET, PIT, and bp-NET was found in successive generations (P < 0.0001). Adjusted analyses led to the same results. CONCLUSIONS: These results suggest the presence of genetic anticipation. However, due to a risk of residual bias, the results must be interpreted with caution. After independent validation in other cohorts and further translational research investigating the molecular mechanisms explaining this phenomenon in MEN1, the results might add to future, more personalized, screening protocols and earlier screening for future generations of MEN1 patients

A Novel Fluorescent Imaging Agent for Diffuse Optical Tomography of the Breast: First Clinical Experience in Patients

Purpose: This is the first clinical evaluation of a novel fluorescent imaging agent (Omocianine) for breast cancer detection with diffuse optical tomography (DOT). Procedures: Eleven women suspected of breast cancer were imaged with DOT at multiple time points (up to 24 h) after receiving an intravenous injection of Omocianine (doses 0.01 to 0.1 mg/kg bodyweight). Breast MRI was obtained for comparison. Results: Histopathology showed invasive cancer in ten patients and fibroadenoma in one patient. With the lowest dose of Omocianine, two of three lesions were detected; with the second dose, three of three lesions were detected; with the two highest doses, none of five lesions were detected. Lesion location on DOT showed excellent agreement with MRI. Optimal lesion-tobackground signals were obtained after 8 h. No adverse events occurred. Conclusions: Lowest doses of Omocianine performed best in lesion detection; DOT using a lowdose fluorescent agent is feasible and safe for breast cancer visualization in patients

NEXT: Generating tailored ERP applications from ontological enterprise models

Tailoring Enterprise Resource Planning (ERP) software to the needs of the enterprise still is a technical endeavor, often requiring the (de)activation of modules, modification of configuration files or even execution of database queries. Considering the large body of work on Enterprise Modeling and Model-Driven Software Engineering, this is remarkable: Ideally, one models one’s own enterprise and, at the press of a button, ERP software tailored to the needs of the modeled enterprise is generated. In this paper, we introduce NEXT, a novel model-driven software generation approach being developed with precisely this goal in mind. It uses the expressive power of ontological enterprise models (OEMs) to generate ERP cloud applications. An OEM only describes the real-world phenomena essential to the enterprise, using terms and customizations specific to the enterprise. We present our considerations during development of the OEM modeling language, which is designed to capture the specifics of enterprise phenomena in a way that technical details can be derived from it. We expect NEXT to drastically shorten the time-to-market of ERP software, from months–years to hours–days

Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

Background In patients with out‐of‐hospital cardiac arrest without ST‐segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out‐of‐hospital cardiac arrest. Methods and Results A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost‐prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND‐36 and collected at 12‐month follow‐up. Overall total mean costs were similar between both groups (EUR 33 575±19 612 versus EUR 33 880±21 044; P=0.86). Generalized linear model: (β, 0.991; 95% CI, 0.894–1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 versus EUR 3028±4220; P<0.001). Costs concerning intensive care unit and ward stay did not show any significant difference. The RAND‐36 questionnaire did not differ between both groups. Conclusions The mean total costs between patients with out‐of‐hospital cardiac arrest randomly assigned to an immediate angiography or a delayed invasive strategy were similar during the initial hospital stay. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered. Registration URL: https://trialregister.nl; Unique identifier: NL4857