Een 21-jarige Somaliër met spier- en gewrichtspijn en aanhoudende koorts

status: publishe

Eightfold increased membrane flux of NF 270 by O3 oxidation of natural humic acids without deteriorated permeate quality

BACKGROUND: Membrane fouling by humic acids limits the water recovery of nanofiltration in drinking water production. This article investigates if membrane fouling can be reduced by decomposition of humic acids in the concentrate stream by O3 oxidation. RESULTS: At a specific O3 dose of 2.11 g O3 per g COD (17.0 g m-3 O3 (g) for 20 minutes), a COD reduction of 38% and a hydrophobic COD reduction of 69% is achieved. The membrane permeability of the ozonated solution by NF 270 membranes is higher (20.6 . 10-9 L s-1 m-2 Pa-1) than the permeability if the untreated solution is filtered (2.4 . 10-9 L s-1 m-2 Pa-1). The COD retention of the ozonated solution was similar to the retention of the untreated samples. The addition of H2O2 allows to obtain a better mineralization degree, i.e., UVA removal increased from 53% to 66% if H2O2 was added as from 10 minutes oxidation at the same molar flow rate as O3. CONCLUSION: O3 oxidation can substantially alleviate membrane fouling by humic acids in nanofiltration systems and the addition of H2O2 can slightly improve its decomposition.status: publishe

Forgoing treatment at the end of life in 6 european countries.

Background: Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient's life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics. Methods: Between June 2001 and February 2002, samples were obtained from deaths reported to registries in Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. The reporting physician was then sent a questionnaire about the medical decision-making process that preceded the patient's death. Results: The incidence of nontreatment decisions, whether or not combined with other end-of-life decisions, varied widely from 6% of all deaths studied in Italy to 41% in Switzerland. Most frequently forgone in every country were hydration or nutrition and medication, together representing between 62% (Belgium) and 71% (Italy) of all treatments withheld or withdrawn. Forgoing treatment estimated to prolong life for more than I month was more common in the Netherlands (10%), Belgium (9%), and Switzerland (8%) than in Denmark (5%), Italy (3%), and Sweden (2%). Relevant determinants of treatment being withheld rather than withdrawn were older age (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.31-1.79), death outside the hospital (death in hospital: OR, 0.80; 95% CI, 0.68-0.93), and greater lifeshortening effect (OR, 1.75; 95% Cl, 1.27-2.39). Conclusions: In all of the participating countries, life prolonging treatment is withheld or withdrawn at the end of life. Frequencies vary greatly among countries. Low technology interventions, such as medication or hydration or nutrition, are most frequently forgone. in older patients and outside the hospital, physicians prefer not to initiate life-prolonging treatment at all rather than stop it later

End-of-life decision-making in six European countries: descriptive study

BACKGROUND: Empirical data about end-of-life decision-making practices are scarce. We aimed to investigate frequency and characteristics of end-of-life decision-making practices in six European countries: Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. METHODS: In all participating countries, deaths reported to death registries were stratified for cause (apart from in Switzerland), and samples were drawn from every stratum. Reporting doctors received a mailed questionnaire about the medical decision-making that had preceded the death of the patient. The data-collection procedure precluded identification of any of the doctors or patients. All deaths arose between June, 2001, and February, 2002. We weighted data to correct for stratification and to make results representative for all deaths: results were presented as weighted percentages. FINDINGS: The questionnaire response rate was 75% for the Netherlands, 67% for Switzerland, 62% for Denmark, 61% for Sweden, 59% for Belgium, and 44% for Italy. Total number of deaths studied was 20480. Death happened suddenly and unexpectedly in about a third of cases in all countries. The proportion of deaths that were preceded by any end-of-life decision ranged between 23% (Italy) and 51% (Switzerland). Administration of drugs with the explicit intention of hastening death varied between countries: about 1% or less in Denmark, Italy, Sweden, and Switzerland, 1.82% in Belgium, and 3.40% in the Netherlands. Large variations were recorded in the extent to which decisions were discussed with patients, relatives, and other caregivers. INTERPRETATION: Medical end-of-life decisions frequently precede dying in all participating countries. Patients and relatives are generally involved in decision-making in countries in which the frequency of making these decisions is high