The challenges of integrating hydrogen in the Dutch natural gas infrastructure: A socio-technical analysis on the challenges of integrating hydrogen in the Dutch gas infrastructure for the provision of gas to the built environment

The Dutch government has announced that 7 million houses and 1 million buildings in the service sector need to be provided by sustainable heat in 2050 (Klimaatberaad, 2018b). This is an enormous challenge considering that over 90 percent of the houses and service sector buildings in the Netherlands are currently heated by the local combustion of natural gas (Hans Ariëns, 2018). The objective of this policy measure is in line with the European climate targets to mitigate the effect of climate change (Klimaatberaad, 2018a). Moreover, it helps to facilitate the Dutch policy to stop the natural gas extraction from the largest natural gas field in the Netherlands (Klimaatberaad, 2018a). To achieve the enormous objective in 2050, the Dutch government is choosing a gradual approach and formulated a first clear policy target for 2030. The CO2 emissions of the buildings induced by space heating and domestic water heating need to be reduced by 3,4 Mt compared to the 1990 levels (Klimaatberaad, 2018a). Sustainability measures in the service sector should lead to a reduction of 1 Mt and phasing out natural gas in 1.5 million houses in combination with insulation measures should cover the remainder of 2 Mt (Klimaatberaad, 2018a). To adequately meet the demand for space heating and domestic water heating in 2030 and beyond, alternative heating technologies need to be integrated in the energy infrastructures to provide the desired energy demand to the buildings. Natural gas is currently distributed by means of an extensive gas infrastructure. There is a potential to use the existing infrastructure to distribute and store sustainable gasses such as biomethane or hydrogen (Dodds & McDowall, 2013). Alternative energy infrastructures can also replace the natural gas infrastructure in the satisfaction of the energy demand. Possibilities are the electricity infrastructure and a district heating infrastructure. Energy can also be produced locally from renewable energy sources as biomass, geothermal energy, solar energy, and wind energyComplex Systems Engineering and Management (CoSEM

An Adolescent With a Retropharyngeal Swelling: To Drain or Not to Drain?: Keeping a Broad Vision During the COVID-19 Pandemic

CASE PRESENTATION: An 18-year-old patient with a history of COVID-19 (1 month previously) was admitted with malaise and complaints of a stiff neck, a left-sided cervical mass, headache, and difficulty in swallowing and breathing, which had been present for 4 days. Two days after the onset of the first symptoms, a painless skin rash on the legs, arms, palms of both hands, and soles of both feet developed. Despite 2 days of treatment with antibiotics (amoxicillin/clavulanic acid, 500/125 mg three times daily orally), symptoms progressed. On presentation, the patient was alert and oriented, there were no neurologic disorders, and all symptoms related to the recent COVID-19 infection had subsided. His medical history was negative for sexually transmitted diseases, and the patient had received all vaccines except for meningococcus and COVID-19

Disability and pain after cortisone versus placebo injection for trapeziometacarpal arthrosis and de Quervain syndrome

This study tested the null hypothesis that type of injection (corticosteroid vs. placebo) is not a predictor of arm-specific disability as measured with the Disabilities of Arm, Shoulder and Hand questionnaire 1 to 3 months after injection of dexamethasone or placebo for treatment of trapeziometacarpal (TMC) arthrosis or de Quervain syndrome. Secondly, we tested if type of injection was a predictor of pain intensity. Thirty-six English-speaking adults with TMC arthrosis or de Quervain syndrome were randomized for a dexamethasone or a placebo injection. At time of the injection, patients completed a demographic data sheet and validated questionnaires assessing arm-specific disability, pain intensity, depressive symptoms, pain catastrophizing, and patient's health-related beliefs. At an average of 1.4 ± 0.42 months (range, 0.79-2.5 months) after the injection, patients completed questionnaires regarding arm-specific disability, pain, and treatment satisfaction. Grip and pinch strength measurements were measured at both time points. Bivariable and multivariable analyses assessed predictors of arm-specific disability and pain intensity at follow-up. Type of injection was not a predictor of arm-specific disability or pain intensity 1 to 3 months after injection. The best model both for arm-specific disability and pain intensity at follow-up included pain catastrophizing and explained 18 % and 33 % of the variability, respectively. Catastrophic thinking was a better predictor of both of arm-specific disability and pain intensity than diagnosis or type of injection (steroid vs. placebo) 1to 3 months after an injectio

The national hospital discharge survey and nationwide inpatient sample: The databases used affect results in THA research

BACKGROUND: The National Hospital Discharge Survey (NHDS) and the Nationwide Inpatient Sample (NIS) collect sample data and publish annual estimates of inpatient care in the United States, and both are commonly used in orthopaedic research. However, there are important differences between the databases, and because of these differences, asking these two databases the same question may result in different answers. The degree to which this is true for arthroplasty-related research has, to our knowledge, not been characterized. QUESTION/PURPOSES: We tested the following null hypotheses: (1) there are no differences between the NHDS and NIS in patient characteristics, comorbidities, and adverse events in patients with hip osteoarthritis treated with THA, and (2) there are no differences between databases in factors associated with inpatient mortality, adverse events, and length of hospital stay after THA. METHODS: The NHDS and NIS databases use different methods of data collection and weighting to provide data representative of all nonfederal hospital discharges in the United States. In 2006 the NHDS database contained 203,149 patients with hip arthritis treated with hip arthroplasty, and the NIS database included 193,879 patients. Multivariable analyses for factors associated with inpatient mortality, adverse events, and days of care were constructed for each database. RESULTS: We found that 26 of 42 of the factors in demographics, comorbidities, and adverse events after THA in the NIS and NHDS databases differed more than 10%. Age and days of care were associated with inpatient mortality with the NHDS and the NIS although the effect rates differ more than 10%. The NIS identified seven other factors not identified by the NHDS: wound complications, congestive heart failure, new mental disorder, chronic pulmonary disease, dementia, geographic region Northeast, acute postoperative anemia, and sex, that were associated with inpatient mortality even after controlling for potentially confounding variables. For inpatient adverse events, atrial fibrillation, osteoporosis, and female sex were associated with the NHDS and the NIS although the effect rates differ more than 10%. There were different directions for sources of payment, dementia, congestive heart failure, and geographic region. For longer length of stay, common factors differing more than 10% in effect rate included chronic pulmonary disease, atrial fibrillation, complication not elsewhere classified, congestive heart failure, transfusion, discharge nonroutine compared with routine, acute postoperative anemia, hypertension, wound adverse events, and diabetes mellitus, whereas discrepant factors included geographic region, payment method, dementia, sex, and iatrogenic hypotension. CONCLUSIONS: Studies that use large databases intended to be representative of the entire United States population can produce different results, likely related to differences in the databases, such as the number of comorbidities and procedures that can be entered in the database. In other words, analyses of large databases can have limited reliability and should be interpreted with caution. LEVEL OF EVIDENCE: Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence

Sensorineural Hearing Impairment Recovery after Transmastoidal Surgery for a Petrous Apex Cholesterol Granuloma:A Case Report

Cholesterol granulomas are the most common primary lesions of the petrous apex. Although their benign character, impingement of critical neurovascular structures can cause significant symptomatology such as hearing impairment. We present unique results after treatment of a cholesterol granuloma located in the petrous apex causing sensorineural hearing impairment. A transmastoidal approach was performed using an intraoperative computed tomography-guided navigation system. The video, which is included for reference, illustrates clear drainage of the cyst and drain positioning. The hearing improved completely in the lower frequencies at 500 and 1000 Hz and with a 19 dB improvement in overall bone conduction in the affected ear

Relationships between pain misconceptions, disability, patients' goals and interpretation of information from hand therapists

Introduction: Patient interpretation of advice from hand therapists may be related to nonadaptive pain thoughts (automatic, overprotective, unduly pessimistic statements triggered by nociception and exacerbated by psychological distress). Purpose of the study: This study aimed to determine whether there were correlations between participants' hand therapy goals, interpretation of advice from hand therapists, nonadaptive pain thoughts, and upper extremity-specific disability. Methods: One hundred and five participants completed questionnaires assessing nonadaptive pain thoughts, upper extremity-specific disability, lessons from hand therapists, and hand therapy goals. Results: Nonadaptive pain thoughts correlated with disability and were bi-directionally related to participant goals and interpretation of advice from hand therapists. Discussion: Patients' nonadapative pain thoughts and the words/concepts used by hand therapists are both important in recovery from upper extremity illness. Conclusions: Hand therapists should be mindful that nonadaptive pain thoughts are an important determinant of disability and that such thoughts can affect and be affected by their recommendations. Level of evidence: n/a (C) 2014 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserve

Clinical characteristics and an evaluation of predictors for a favourable outcome of Mycobacterium abscessus otomastoiditis:a systematic review and meta-analysis of individual participant data

BACKGROUND: Otomastoiditis caused by Mycobacterium abscessus is rare, but its incidence has increased over the past decades and its optimal treatment remains unknown. This study aims to summarise the clinical and therapeutic features and find characteristics of patients with M. abscessus otomastoiditis associated with favourable treatment outcomes. METHODS: We searched MEDLINE, Embase and Web of Science to identify studies including patients with M. abscessus otomastoiditis. A 1-stage individual patient data (IPD) meta-analysis was conducted. A 2-level mixed-effects linear regression model was provided for antimycobacterial treatment duration. RESULTS: Twenty-three studies reported a total of 85 patients. Children possess a unique clinical profile including a history of ear infections, tympanostomy tube placement and antibiotic treatment. Antimycobacterial treatment was administered for 26 (interquartile range [IQR]: 15-35) weeks. Macrolides were prescribed in 98.8% of the cases. Surgery was performed in 80.5% of the cases, of which, 47.1% required revision surgery. Otalgia was a significant predictor (β = 9.3; P = .049) of antimycobacterial treatment duration. CONCLUSIONS: Mastoid surgery (regularly requiring revision) and a multidrug regimen for a minimum of 6 months, including a minimum of 3 active agents, are most often needed to attain cure. The presence of otalgia significantly extends the treatment duration of M. abscessus otomastoiditis

Diagnosis, treatment and prognosis of otomastoiditis induced by Fusobacterium necrophorum:A retrospective multicentre cohort study

OBJECTIVES: Otomastoiditis caused by the anaerobic Fusobacterium necrophorum (F. necrophorum) often induces severe complications, such as meningitis and sinus thrombosis. Early diagnosis is difficult, partly because little is known about specific early signs. Comprehensive research about clinically chosen antimicrobial therapy has not been done yet and prognostic information about otomastoiditis caused by F. necrophorum is scarce. More knowledge about this subject is required. METHODS: In this retrospective cohort study, we included all cases of otomastoiditis caused by F. necrophorum treated in two university medical centres in the Netherlands during the past 10 years. Data was gathered from patient records and analysed using independent sample T-tests and Chi2-tests. RESULTS: This study reveals that otomastoiditis caused by F. necrophorum potentially induces neurological sequelae. Thereby, 80% of all included patients (n = 16) needed readmission within six months due to recurrence or complications of otomastoiditis caused by F. necrophorum. Mean (range) of age, CRP and temperature were 4.5 years (0.9-29.3), 243 mg/L (113-423) and 40 °C (37-41). All patients were hospitalized and treated with antibiotics, mostly metronidazole (n = 13/16) and a β -lactam (n = 15/16). Additional treatment contained low molecular weight heparin (83%, n = 10/12), dexamethasone (78%, n = 7/9) and/or surgery (80%, n = 12/16, whereof 9/12 mastoidectomy). CONCLUSIONS: Patients and/or their parents need to be informed about this potential unfortunate prognosis when otomastoiditis caused by F. necrophorum is diagnosed. To improve early diagnosis, otomastoiditis caused by F. necrophorum should be suspected and therefore immediately cultured when a) young children present with otomastoiditis, with b) high CRP values, and/or c) vomiting and decreased consciousness