Onderwijs-, Arbeidsmarkt- en Skillsmonitor 2018: Metropoolregio Amsterdam

FdR – Publicaties zonder aanstelling Universiteit Leide

Negative calcium balance despite normal plasma ionized calcium concentrations during citrate anticoagulated continuous venovenous hemofiltration (CVVH) in ICU patients

Background: Supplementation of calcium during continuous venovenous hemofiltration (CVVH) with citrate anticoagulation is usually titrated using a target blood ionized calcium concentration. Plasma calcium concentrations may be normal despite substantial calcium loss, by mobilization of calcium from the skeleton. Aim of our study is to develop an equation to calculate CVVH calcium and to retrospectively calculate CVVH calcium balance in a cohort of ICU-patients. Methods: This is a single-center retrospective observational cohort study. In a subcohort of patients, all calcium excretion measurements in patients treated with citrate CVVH were randomly divided into a development set (n = 324 in 42 patients) and a validation set (n = 441 in 42 different patients). Using mixed linear models, we developed an equation to calculate calcium excretion from routinely available parameters. We retrospectively calculated calcium balance in 788 patients treated with citrate CVVH between 2014 and 2021. Results: Calcium excretion (mmol/24 h) was - 1.2877 + 0.646*[Ca](blood,total) * ultrafiltrate (l/24 h) + 0.107*blood flow (ml/h). The mean error of the estimation was - 1.0 +/- 6.7 mmol/24 h, the mean absolute error was 4.8 +/- 4.8 mmol/24 h. Calculated calcium excretion was 105.8 +/- 19.3 mmol/24 h. Mean daily CVVH calcium balance was - 12.0 +/- 20.0 mmol/24 h. Mean cumulative calcium balance ranged from - 3687 to 448 mmol. Conclusion: During citrate CVVH, calcium balance was negative in most patients, despite supplementation of calcium based on plasma ionized calcium levels. This may contribute to demineralization of the skeleton. We propose that calcium supplementation should be based on both plasma ionized calcium and a simple calculation of calcium excretion by CVVH.[GRAPHICS].Afdeling Klinische Chemie en Laboratoriumgeneeskunde (AKCL

Additional surgical procedures and perioperative morbidity in post-chemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer in two intermediate volume hospitals

Purpose: To evaluate the perioperative morbidity of PC-RPLND in two intermediate volume centers and to identify predictors of high morbidity. Methods: Retrospective analysis of 124 patients treated with open PC-RPLND at two tertiary referral centers between 2001 and 2018. Perioperative morbidity was determined by analyzing additional surgical procedures, intra-operative blood loss, and postoperative complications. Results: An additional procedure was necessary for 33 patients (26.6%). The risk was higher in patients with IGCCCG intermediate/poor prognosis (OR 3.56; 95% CI 1.33–9.52) and residual tumor size > 5 cm (OR 3.53; 95% CI 1.39–8.93). Blood loss was higher in patients with IGCCCG intermediate/poor prognosis (β = 0.177; p = 0.029), large residual tumor (β = 0.570; p < 0.001), an additional intervention (β = 0.342; p < 0.001) and teratoma on retroperitoneal histology (β = − 0.19; p = 0.014). Thirty-one patients had a postoperative complication Clavien-Dindo Grade ≥ 2 (25.0%). Complication risk was highest in patients undergoing an additional intervention (OR 3.46; 95% CI 1.03–11.60; p = 0.044). Conclusions: The rate of additional interventions in our series is comparable to what has been reported in high-volume centers. IGCCCG intermediate/poor prognosis patients with high-volume disease and patients undergoing an additional surgical procedure can be classified as high-risk patients

Institutional balance and sincere cooperation in treaty-making under EU law

A stream of recent judgments by the Grand Chamber of the European Court of Justice has shed light on the procedures that govern treaty-making by the European Union. This article explores how this case-law aproaches the principle of institutional balance and the duty of cooperation between the institutions. It argues that the former is construed in a balanced manner on the basis of a literal interpretation of primary law that promotes strict compliance with procedural rules and does not favour a particular institution. As for the duty of cooperation, whilste its procedural dimension is strengthened, its scope remains somewhat elusive. The analysis identifies a pragmatic streak in the Court’s balanced approach, and argues that there is an inherent limit to the impact of constitutional law on inter-institutional disputes. Ultimately, the less time and energy the institutions waste on turf wars about their procedural powers, the greater their contribution to inceasing the efficiency of the Union’s treaty-making practice

Client-oriented evaluation of ‘creative destruction’ in policy mixes: Finnish policies on building energy efficiency transition

This article connects the literatures of policy evaluation, policy mixes and sustainability transition. It utilises client-oriented evaluation to examine national policies in Finland from the perspective of low-carbon buildings transition. In Finland, energy efficiency has traditionally received less focus in energy and climate policy strategies compared to renewable energy. Since 2007, energy efficiency policies addressing buildings gained force. Sixteen new policy instruments were implemented during 2007–2014 and several revisions were made to the building code energy efficiency requirements. To what extent these changes contribute to ‘creative destruction’ in the policy domain is uncertain. Therefore, we conduct a client-oriented evaluation of the policy mix from the perspective of a boundary actor—integrated energy service companies—to analyse its potential for facilitating zero-carbon transition. The findings show a divergence of opinions regarding the policy mix’s disruptive influence. Where potentially disruptive policy instruments can be found, their impact is reduced due to incoherence in policy implementation processes. The usability of client-oriented evaluation for policy mix analysis is found limited on its own but useful in complementing top-down policy evaluations. We also propose an additional function to the creative destruction policy mix: ‘changes in organisational and institutional practices’, linking to the coherence of policy mixes

Feasibility of clinical studies of chemical exchange saturation transfer magnetic resonance imaging of prostate cancer at 7 T

Chemical exchange saturation transfer (CEST) has been explored for differentiation between tumour and benign tissue in prostate cancer (PCa) patients. With ultrahigh field strengths such as 7-T, the increase of spectral resolution and sensitivity could allow for selective detection of amide proton transfer (APT) at 3.5 ppm and a group of compounds that resonate at 2 ppm (i.e., [poly]amines and/or creatine). The potential of 7-T multipool CEST analysis of the prostate and the detection of PCa was studied in patients with proven localised PCa who were scheduled to undergo robot-assisted radical prostatectomy (RARP). Twelve patients were prospectively included (mean age 68.0 years, mean serum prostate-specific antigen 7.8ng/mL). A total of 24 lesions larger than 2 mm were analysed. Used were 7-T T2-weighted (T2W) imaging and 48 spectral CEST points. Patients received 1.5-T/3-T prostate magnetic resonance imaging and galium-68-prostate-specific membrane antigen-positron emission tomography/computerised tomography to determine the location of the single-slice CEST. Based on the histopathological results after RARP, three regions of interest were drawn on the T2W images from a known malignant zone and benign zone in the central and peripheral zones. These areas were transposed to the CEST data, from which the APT and 2-ppm CEST were calculated. The statistical significance of the CEST between the central zone, the peripheral zone, and tumour was calculated using a Kruskal-Wallis test. The z-spectra showed that APT and even a distinct pool that resonated at 2 ppm were detectable. This study showed a difference trend in the APT levels, but no difference in the 2-ppm levels when tested between the central zone, the peripheral zone, and tumour (H(2) = 4.8, p = 0.093 and H(2) = 0.86, p = 0.651, respectively). Thus, to conclude, we could most likely detect APT and amines and/or creatine levels noninvasively in prostate using the CEST effect. At group level, CEST showed a higher level of APT in the peripheral versus the central zone; however, no differences of APT and 2-ppm levels were observed in tumours

The Economic Case for Low Carbon Development in Rapidly Growing Developing World Cities: A case study of Palembang, Indonesia.

Where costs or risks are higher, evidence is lacking or supporting institutions are less developed, policymakers can struggle to make the case for low-carbon investment. This is especially the case in developing world cities where decision-makers struggle to keep up with the pace and scale of change. Focusing on Palembang in Indonesia, this paper considers the economic case for proactive investment in low-carbon development. We find that a rapidly growing industrial city in a developing country can reduce emissions by 24.1% in 2025, relative to business as usual levels, with investments of USD405.6 million that would reduce energy expenditure in the city by USD436.8 million. Emissions from the regional grid could be reduced by 12.2% in 2025, relative to business as usual trends, with investments of USD2.9 billion that would generate annual savings of USD175 million. These estimates understate the savings from reduced expenditure on energy subsidies and energy infrastructure. The compelling economic case for mainstreaming climate mitigation in this developing country city suggests that the constraints on climate action can be political and institutional rather than economic. There is therefore a need for more effective energy governance to drive the transition to a low-carbon economy

An exploratory policy analysis of electric vehicle sales competition and sensitivity to infrastructure in Europe

This research contributes to discussions about policy interventions to stimulate the transition of vehicle technology. Concentrating on passenger cars, an extensive system dynamics based market agent model of powertrain technology transitions within the EU up to 2050 is employed. With a focus on subsidy scenarios for both infrastructure deployment and vehicle purchase, and set within the context of the EU fleet emission regulations, we find that there are important interactions between different powertrain types and with infrastructure provision. For example, strong plug-in electric vehicle (PiEV) policy could inhibit the maturity of hydrogen fuel cell vehicles. Infrastructure provision is important for improving the utility of a PiEV, but we find that in the early market it may have a weaker correlation with uptake than other policy options, until the PiEV stock share is over around 5%. Furthermore, an attempt to install a ratio of much more than one charge point per 10 PiEV may lead to little gains and high costs. PiEV sales are relatively insensitive at target levels over 25 PiEV per charge point. The results of our study can help policymakers to find the right balance and timing of measures targeting the transition towards low carbon alternative vehicles

Assessment of spatial variability of multiple ecosystem services in grasslands of different intensities

Grasslands provide multiple Ecosystem Services (ES) such as forage provision, carbon sequestration or habitat provision. Knowledge about the trade-offs between these ES is of great importance for grassland management. Yet, the outcome of different management strategies on ES provision is highly uncertain due to spatial variability. We aim to characterize the provision (level and spatial variability) of grassland ES under various management strategies. To do so, we combine empirical data for multiple ES with spatially explicit census data on land use intensities. We analyzed the variations of five ES (forage provision, climate regulation, pollination, biodiversity conservation and outdoor recreation) using data from biodiversity fieldwork, experimental plots for carbon as well as social network data from Flickr. These data were used to calculate the distribution of modelled individual and multiple ES values from different grassland management types in a Swiss case study region using spatial explicit information for 17,383 grassland parcels. Our results show that (1) management regime and intensity levels play an important role in ES provision but their impact depends on the ES. In general, extensive management, especially in pastures, favors all ES but forage provision, whereas intensive management favors only forage provision and outdoor recreation; (2) ES potential provision varies between parcels under the same management due to the influence of environmental drivers, related to topography and landscape structure; (3) there is a trade-offs between forage provision and other ES at the cantonal level but a synergy between forage provision and biodiversity conservation within the grassland categories, due to the negative impact of elevation on both ES. Information about multiple ES provision is key to support effective agri-environmental measures and information about the spatial variability can prevent uncertain outputs of decision-making processes