Plastic glazen onder de loep : oriënterend onderzoek naar hygiëne en duurzaamheid van harde plastic retourglazen op buitenevementen

In dit verkennende onderzoek is gekeken naar de duurzaamheid en hygiëne van harde plastic glazen, die op buitenevenementen gebruikt worden. Het onderzoek is gedaan in opdracht van de Koninklijke Horeca Nederland (KNH), de brancheorganisatie voor horecaondernemers. De verzamelde informatie is verkregen aan de hand van literatuuronderzoek en interviews met een klein aantal betrokkenen. Zo is gesproken met een producent / verhuurder van zulke glazen en met horecaondernemers over hun ervaringen met de glazen in de praktijk. Hierbij is veel aandacht uitgegaan naar spoelmethoden en gebruik. Naast interviews is er ook een kleinschalig laboratoriumonderzoek geweest waarbij gekeken is naar het voorkomen van micro-organismen op glazen afkomstig van verschillende locaties. Ten eerste is gekeken naar de eigenschappen van polycarbonaat (PC-)glazen. De eigenschappen van de glazen bepalen namelijk in grote mate de duurzaamheid. Doordat polycarbonaat een zachter materiaal is dan glas, kunnen er makkelijker krasjes in het oppervlak van plastic glazen ontstaan dan bij gewone glazen. Wellicht heeft dit gevolgen voor de hygiëne. Vervolgens zijn voor- en de nadelen van de PC-glazen op een rij gezet. Voordelen zijn bijvoorbeeld de mogelijkheid tot hergebruik ten opzichte van plastic wegwerpglazen en de onbreekbaarheid ten opzichte van gewone glazen. De evenementen zijn hierdoor schoner en veiliger. Nadelen zijn dat invoering en gebruik van harde plastic glazen voor de ondernemers extra kosten met zich mee kan brengen door aanschaf, vervanging en logistiek. Daarnaast kan door het gebruik van plastic glazen de kwaliteit van de drank in het geding komen, zoals hygiëne, smaak en schuimkraag van het bier. Ook is gekeken naar de mogelijkheid van overdracht van micro-organismen door het drinken uit de harde plastic glazen. Door goede hygiëne kan een besmetting beperkt worden, en daarmee het verspreiden van infectieziekten. Infecties worden door verschillende micro-organismen veroorzaakt, waaronder bacteriën, schimmels en virussen. Het is voor dit onderzoek alleen relevant te kijken naar veel voorkomende mondinfecties. Met de gangbare regels voor spoelen en desinfecteren, zoals beschreven in de hygiënecode is gekeken naar de overlevingskansen van relevante micro-organismen

A framework for assessing the impact of cardiac and respiratory motion for STereotactic Arrhythmia Radioablation (STAR) using a digital phantom with a 17-segment model - A STOPSTORM.eu consortium study

The optimal motion management strategy for patients receiving stereotactic arrhythmia radioablation (STAR) for the treatment of ventricular tachycardia (VT) is not fully known. We developed a framework using a digital phantom to simulate cardiorespiratory motion in combination with different motion management strategies to gain insight into the impact of cardiorespiratory motion on STAR. The 4D XCAT phantom was expanded with the 17-segment left ventricular (LV) model which allowed placement of STAR targets in standardized ventricular regions. Cardiac- and respiratory-binned 4D-CT scans were simulated for free-breathing, reduced free-breathing, respiratory-gating, and breath-hold scenarios. Respiratory motion of the heart was set to population-averaged values of VT patients: 6, 2, and 1 mm in the Superior-Inferior, Posterior-Anterior, and Left-Right direction, respectively. Cardiac contraction was adjusted by reducing LV ejection fraction to 35%. Target displacement was evaluated for all segments using envelopes encompassing the cardiorespiratory motion. Envelopes incorporating only the diastole plus respiratory motion were created to simulate the scenario where cardiac motion is not fully captured on 4D-respiratory CT scans used for radiotherapy planning. The average volume of the 17 segments was 6 cm (1-9 cm ). Cardiac contraction-relaxation resulted in maximum segment (centroid) motion of 4, 6, and 3.5 mm in Superior-Inferior, Posterior-Anterior, and Left-Right direction, respectively. Cardiac contraction-relaxation resulted in a motion envelope increase of 49% (24-79%) compared to individual segment volumes, whereas envelopes increased by 126% (79-167%) if also respiratory motion was considered. Envelopes incorporating only the diastole and respiration motion covered on average 68-75% of the motion envelope. The developed LV-segmental XCAT framework showed that free-wall regions display the most cardiorespiratory displacement. Our framework supports the optimization of STAR by evaluating the impact of (cardio)respiratory motion and motion management strategies for VT patients

Rationale and Design of the ISOLATION Study: A Multicenter Prospective Cohort Study Identifying Predictors for Successful Atrial Fibrillation Ablation in an Integrated Clinical Care and Research Pathway

Introduction: Continuous progress in atrial fibrillation (AF) ablation techniques has led to an increasing number of procedures with improved outcome. However, about 30–50% of patients still experience recurrences within 1 year after their ablation. Comprehensive translational research approaches integrated in clinical care pathways may improve our understanding of the complex pathophysiology of AF and improve patient selection for AF ablation. Objectives: Within the “IntenSive mOlecular and eLectropathological chAracterization of patienTs undergoIng atrial fibrillatiOn ablatioN” (ISOLATION) study, we aim to identify predictors of successful AF ablation in the following domains: (1) clinical factors, (2) AF patterns, (3) anatomical characteristics, (4) electrophysiological characteristics, (5) circulating biomarkers, and (6) genetic background. Herein, the design of the ISOLATION study and the integration of all study procedures into a standardized pathway for patients undergoing AF ablation are described. Methods: ISOLATION (NCT04342312) is a two-center prospective cohort study including 650 patients undergoing AF ablation. Clinical characteristics and routine clinical test results will be collected, as well as results from the following additional diagnostics: determination of body composition, pre-procedural rhythm monitoring, extended surface electrocardiogram, biomarker testing, genetic analysis, and questionnaires. A multimodality model including a combination of established predictors and novel techniques will be developed to predict ablation success. Discussion: In this study, several domains will be examined to identify predictors of successful AF ablation. The results may be used to improve patient selection for invasive AF management and to tailor treatment decisions to individual patients

STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe.

The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs