Воспитание толерантности в процессе преподавания гуманитарных дисциплин

Objective: To assess whether patient characteristics add to the fetal fibronectin test and cervical length measurement in the prediction of preterm delivery in symptomatic women. Study design: A nationwide prospective cohort study was conducted in all ten perinatal centres in the Netherlands. Women with symptoms of preterm labour between 24 and 34 weeks gestation with intact membranes were invited. In all women qualitative fibronectin testing (0.050 tig/mL cut-off) and cervical length measurement were performed. Only singleton pregnancies were included in this analysis. Logistic regression was used to construct two multivariable models to predict spontaneously delivery within 7 days: a model including cervical length and fetal fibronectin as predictors, and an extended model including all potential predictors. The models were internally validated using bootstrapping techniques. Predictive performances were assessed as the area under the receiver operator characteristic curve (AUC) and calibration plots. We compared the models' capability to identify women with a low risk to deliver within 7 days. A risk less than 5%, corresponding to the risk for women with a cervical length of at least 25 mm, was considered as low risk. Results: Seventy-three of 600 included women (12%) had delivered spontaneously within 7 days. The extended model included maternal age, parity, previous preterm delivery, vaginal bleeding, C-reactive protein, cervical length, dilatation and fibronectin status. Both models had high discriminative performances (AUC of 0.92 (95% CI 0.88-0.95) and 0.95 (95% CI 0.92-0.97) respectively). Compared to the model with fibronectin and cervical length, our extended model reclassified 38 women (6%) from low risk to high risk and 21 women (4%) from high risk to low risk. Preterm delivery within 7 days occurred once in both the reclassification groups. Conclusion: In women with symptoms of preterm labour before 34 weeks gestation, a model that integrates maternal characteristics, clinical signs and laboratory tests, did not predict delivery within 7 days better than a model with only fibronectin and cervical length. (C) 2015 Elsevier Ireland Ltd. All rights reserved

Exploring the applicability of the pregnancy and childbirth outcome set: A mixed methods study

Objective: The International Consortium for Health Outcomes Measurement developed the Pregnancy and Childbirth (PCB) outcome set to improve value-based perinatal care. This set contains clinician-reported outcomes and patient-reported outcomes. We validated the set for use in the Netherlands by exploring its applicability among all end-users prior to implementation. Methods: A mixed-methods design was applied. A survey was performed to assess patients (n = 142), professionals (n = 134) and administrators (n = 35) views on the PCB set. To further explore applicability, separate focus groups were held with representatives of each of these groups. Results: The majority of survey participants agreed that the PCB set contains the most important outcomes. Patient-reported experience measures were considered relevant by the majority of participants. Perceived relevance of patient-reported outcome measures varied. Main themes from the focus groups were content of the set, data collection timing, implementation (also IT and transparency), and quality-based governance. Conclusion: This study supports suitability of the PCB outcome set for implementation, evaluation of quality of care and shared decision making in perinatal care. Practice Implications: Implementation of the PCB set may change existing care pathways of perinatal care. Focus on transparency of outcomes is required in order to achieve quality-based governance with proper IT solutions

Artificial intelligence extension of the OSCAR-IB criteria

Artificial intelligence (AI)-based diagnostic algorithms have achieved ambitious aims through automated image pattern recognition. For neurological disorders, this includes neurodegeneration and inflammation. Scalable imaging technology for big data in neurology is optical coherence tomography (OCT). We highlight that OCT changes observed in the retina, as a window to the brain, are small, requiring rigorous quality control pipelines. There are existing tools for this purpose. Firstly, there are human-led validated consensus quality control criteria (OSCAR-IB) for OCT. Secondly, these criteria are embedded into OCT reporting guidelines (APOSTEL). The use of the described annotation of failed OCT scans advances machine learning. This is illustrated through the present review of the advantages and disadvantages of AI-based applications to OCT data. The neurological conditions reviewed here for the use of big data include Alzheimer disease, stroke, multiple sclerosis (MS), Parkinson disease, and epilepsy. It is noted that while big data is relevant for AI, ownership is complex. For this reason, we also reached out to involve representatives from patient organizations and the public domain in addition to clinical and research centers. The evidence reviewed can be grouped in a five-point expansion of the OSCAR-IB criteria to embrace AI (OSCAR-AI). The review concludes by specific recommendations on how this can be achieved practically and in compliance with existing guidelines

Optimizing the stacking sequence in dual-purpose body armors

Many police body armor systems are dual purpose, offering both ballistic and knife resistanceby combining a flexible ballistic textile pack with a stiffer knife resistant layer.The two types of protection differ in materials and mechanisms such that each individualcomponent may help or interfere with the function of the other. This paper investigatesthe effect on knife and ballistic penetration resistance when a single thin metal plate wasplaced at various different positions within an aramid textile armor pack. Two metalliclayers were used: aluminum 7075 and commercial purity titanium; these had similarareal densities and were positioned in the front, middle, and back of a 20 layer pack ofwoven KevlarVR 49. An instrumented drop weight machine was used to deliver a repeatableknife blade impact at comparable energy levels to those specified in the UK HomeOffice test standards for knife resistance. Ballistic tests were used to determine the V50ballistic limit velocity against typical 9mm and 0.357 Magnum handgun threats. Againsta stabbing threat, it was found that positioning the metal plate in the middle of the packprovided the greatest resistance to knife penetration by a factor of almost two, while aplate at the front of the pack provided less resistance and plates positioned at the rear ofthe pack provided the least resistance to penetration. Against the ballistic threat, the penetrationresistance of the textile pack can be significantly improved when a metal plate isat the front of the pack, while for all other positions the effect is negligible. However, thiseffect is sensitive to both the ammunition type and the metal plate composition. When themetal plate is positioned at the rear of the pack there is a significant decrease in theback-face deformation of the armor pack although, again, this effect is only present forcertain ammunition and metal combinations. The overall effect of combining soft andhard elements was that specific performance parameters could be substantially increasedby the correct combination. There were no significant negative effects, however, in anumber of cases, the combined systems performance was no greater than that of a singleelement type, despite the added weight

Eindelijk een antwoord op endotoxinen : nieuwe meetstrategie maakt effectieve aanpak mogelijk

Artikel besteed aandacht aan een door een samenwerkingsverband van TNO en de Universiteit van Utrecht verbeterde analysemethode en meetprotocol voor endotoxinen. Vakmedi

Ayurvedische kruiden bij Hollandse koeproblemen : een verslag van een praktijkproef in Overijssel

Dit rapport beschrijft een proef met een Ayurvedisch recept tegen mastitis bij Nederlandse koeien met hoog celgetal. De proef is opgezet naar aanleiding van een werkbezoek aan India van een groep dierenartsen en boeren uit Overijssel in april 2014, in het kader van een uitwisselingsproject van Oxfam Novib over reductie van antibiotica in de melkveehouderij. In het kader van de reductie van het antibioticagebruik, de verhoging van de diergezondheid en het dierwelzijn is een pilotproef opgezet bij boeren in Overijssel om te onderzoeken of deze middelen ook onder Nederlandse omstandigheden werkzaam zijn