Verbonden door water: van 1984 via het heden naar 2034

Wageningen UR hield in september 2009 een reünie voor oud-studenten, die in 1984 aan hun studie waren begonnen. In dat jaar was de opkomst hoog. Maar liefst 1.200 studenten verschenen aan de start, waarvan ongeveer driekwart de finish haalde. Deze lichting heeft twee hoogleraren voortgebracht en vele promovendi. Beide hoogleraren (Marc Bierkens, Geografische hydrologie aan de Universiteit van Utrecht, en Remko Uijlenhoet, Hydrologie en Kwantitatief waterbeheer aan Wageningen UR) kozen destijds voor dezelfde studierichting Cultuurtechniek, oriëntatie Hydrologie en waterbeheer. Een goed waterjaar, want na 25 jaar blijken ook de andere hydrologen uit 1984 nog steeds geïnspireerd door water en bekleden gevariëerde functies binnen wetenschap, overheid en bedrijfsleven

Multifunctioneel landgebruik als adaptatiestrategie : Puzzelen met ondernemers en beleidsmakers

Het Brabantse landelijke gebied is een dicht bevolkt en gereguleerd landschap. De vraag naar ruimte is groot en vaak conflicterend. Klimaatadaptatie maatregelen gericht op het omgaan met de effecten van klimaatverandering kunnen een extra ruimteclaim leggen op de schaarse ruimte. Het project multifunctioneel landgebruik heeft de volgende resultaten opgeleverd: 1) Een overzicht en analyse van de praktische toepassing van multifunctioneel landgebruik als klimaatadaptatie strategie voor de hoge zandgronden. 2) Inzichten in hoe met actoren te komen tot ideeën voor multifunctioneel landgebruik en hoe deze te implementeren 3) Een Businesscase waarin multifunctioneel gebruik vanuit water, natuur en energie als strategie voor klimaatadaptatie is uitgewerkt

Analyses of cerebral microdialysis in patients with traumatic brain injury: relations to intracranial pressure, cerebral perfusion pressure and catheter placement

<p>Abstract</p> <p>Background</p> <p>Cerebral microdialysis (MD) is used to monitor local brain chemistry of patients with traumatic brain injury (TBI). Despite an extensive literature on cerebral MD in the clinical setting, it remains unclear how individual levels of real-time MD data are to be interpreted. Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) are important continuous brain monitors in neurointensive care. They are used as surrogate monitors of cerebral blood flow and have an established relation to outcome. The purpose of this study was to investigate the relations between MD parameters and ICP and/or CPP in patients with TBI.</p> <p>Methods</p> <p>Cerebral MD, ICP and CPP were monitored in 90 patients with TBI. Data were extensively analyzed, using over 7,350 samples of complete (hourly) MD data sets (glucose, lactate, pyruvate and glycerol) to seek representations of ICP, CPP and MD that were best correlated. MD catheter positions were located on computed tomography scans as pericontusional or nonpericontusional. MD markers were analyzed for correlations to ICP and CPP using time series regression analysis, mixed effects models and nonlinear (artificial neural networks) computer-based pattern recognition methods.</p> <p>Results</p> <p>Despite much data indicating highly perturbed metabolism, MD shows weak correlations to ICP and CPP. In contrast, the autocorrelation of MD is high for all markers, even at up to 30 future hours. Consequently, subject identity alone explains 52% to 75% of MD marker variance. This indicates that the dominant metabolic processes monitored with MD are long-term, spanning days or longer. In comparison, short-term (differenced or Δ) changes of MD vs. CPP are significantly correlated in pericontusional locations, but with less than 1% explained variance. Moreover, CPP and ICP were significantly related to outcome based on Glasgow Outcome Scale scores, while no significant relations were found between outcome and MD.</p> <p>Conclusions</p> <p>The multitude of highly perturbed local chemistry seen with MD in patients with TBI predominately represents long-term metabolic patterns and is weakly correlated to ICP and CPP. This suggests that disturbances other than pressure and/or flow have a dominant influence on MD levels in patients with TBI.</p

A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome

OBJECTIVE: To perform a systematic review on commonly measured cerebral microdialysis (CMD) analytes and their association to: (A) patient functional outcome, (B) neurophysiologic measures, and (C) tissue outcome; after moderate/severe TBI. The aim was to provide a foundation for next-generation CMD studies and build on existing pragmatic expert guidelines for CMD. METHODS: We searched MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016). Strength of evidence was adjudicated using GRADE. RESULTS: (A) Functional Outcome: 55 articles were included, assessing outcome as mortality or Glasgow Outcome Scale (GOS) at 3-6 months post-injury. Overall, there is GRADE C evidence to support an association between CMD glucose, glutamate, glycerol, lactate, and LPR to patient outcome at 3-6 months. (B) Neurophysiologic Measures: 59 articles were included. Overall, there currently exists GRADE C level of evidence supporting an association between elevated CMD measured mean LPR, glutamate and glycerol with elevated ICP and/or decreased CPP. In addition, there currently exists GRADE C evidence to support an association between elevated mean lactate:pyruvate ratio (LPR) and low PbtO2. Remaining CMD measures and physiologic outcomes displayed GRADE D or no evidence to support a relationship. (C) Tissue Outcome: four studies were included. Given the conflicting literature, the only conclusion that can be drawn is acute/subacute phase elevation of CMD measured LPR is associated with frontal lobe atrophy at 6 months. CONCLUSIONS: This systematic review replicates previously documented relationships between CMD and various outcome, which have driven clinical application of the technique. Evidence assessments do not address the application of CMD for exploring pathophysiology or titrating therapy in individual patients, and do not account for the modulatory effect of therapy on outcome, triggered at different CMD thresholds in individual centers. Our findings support clinical application of CMD and refinement of existing guidelines

Dutch Oncology COVID-19 consortium:Outcome of COVID-19 in patients with cancer in a nationwide cohort study

Aim of the study: Patients with cancer might have an increased risk for severe outcome of coronavirus disease 2019 (COVID-19). To identify risk factors associated with a worse outcome of COVID-19, a nationwide registry was developed for patients with cancer and COVID-19. Methods: This observational cohort study has been designed as a quality of care registry and is executed by the Dutch Oncology COVID-19 Consortium (DOCC), a nationwide collaboration of oncology physicians in the Netherlands. A questionnaire has been developed to collect pseudonymised patient data on patients' characteristics, cancer diagnosis and treatment. All patients with COVID-19 and a cancer diagnosis or treatment in the past 5 years are eligible. Results: Between March 27th and May 4th, 442 patients were registered. For this first analysis, 351 patients were included of whom 114 patients died. In multivariable analyses, age ≥65 years (p < 0.001), male gender (p = 0.035), prior or other malignancy (p = 0.045) and active diagnosis of haematological malignancy (p = 0.046) or lung cancer (p = 0.003) were independent risk factors for a fatal outcome of COVID-19. In a subgroup analysis of patients with active malignancy, the risk for a fatal outcome was mainly determined by tumour type (haematological malignancy or lung cancer) and age (≥65 years). Conclusion: The findings in this registry indicate that patients with a haematological malignancy or lung cancer have an increased risk of a worse outcome of COVID-19. During the ongoing COVID-19 pandemic, these vulnerable patients should avoid exposure to severe acute respiratory syndrome coronavirus 2, whereas treatment adjustments and prioritising vaccination, when available, should also be considered

Improved prosthetic hand control with concurrent use of myoelectric and inertial measurements

Abstract Background Myoelectric pattern recognition systems can decode movement intention to drive upper-limb prostheses. Despite recent advances in academic research, the commercial adoption of such systems remains low. This limitation is mainly due to the lack of classification robustness and a simultaneous requirement for a large number of electromyogram (EMG) electrodes. We propose to address these two issues by using a multi-modal approach which combines surface electromyography (sEMG) with inertial measurements (IMs) and an appropriate training data collection paradigm. We demonstrate that this can significantly improve classification performance as compared to conventional techniques exclusively based on sEMG signals. Methods We collected and analyzed a large dataset comprising recordings with 20 able-bodied and two amputee participants executing 40 movements. Additionally, we conducted a novel real-time prosthetic hand control experiment with 11 able-bodied subjects and an amputee by using a state-of-the-art commercial prosthetic hand. A systematic performance comparison was carried out to investigate the potential benefit of incorporating IMs in prosthetic hand control. Results The inclusion of IM data improved performance significantly, by increasing classification accuracy (CA) in the offline analysis and improving completion rates (CRs) in the real-time experiment. Our findings were consistent across able-bodied and amputee subjects. Integrating the sEMG electrodes and IM sensors within a single sensor package enabled us to achieve high-level performance by using on average 4-6 sensors. Conclusions The results from our experiments suggest that IMs can form an excellent complimentary source signal for upper-limb myoelectric prostheses. We trust that multi-modal control solutions have the potential of improving the usability of upper-extremity prostheses in real-life applications