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Despite China’s rise on the world stage and rapid improvements in the quality and quantity of its arms production, little is truly known about Chinese defence groups’ performance. The existing lite...

Background: Beneficial effects of pulmonary rehabilitation at high-altitude (HAPR) in patients with severe refractory asthma have been reported earlier, but evidence for the effectiveness is limited. Aim: To investigate the effectiveness of high-altitude pulmonary rehabilitation to comparable treatment at sea-level (LAPR) on patient outcome parameters. Methods: Adults with severe refractory asthma living in The Netherlands were included. Treatment consisted of a 12-week personalized multidisciplinary rehabilitation program either at high-altitude (Davos Switzerland) (n = 93) or in a tertiary lung center at sea-level in The Netherlands (n = 45). At baseline, after treatment, and during 12 months follow-up asthma related quality of life (AQLQ), asthma control (ACQ), pulmonary function and OCS-dose were assessed. Patients could not be randomized resulting in different asthma populations. Groups were compared using linear regression analysis (ANCOVA) adjusted for baseline values, in addition to age, atopy, smoking history, BMI and gender. Results: After treatment, and at 12 months follow-up, improved AQLQ(0.92,p < 0.001 and 0.82,p = 0.001, respectively), ACQ(-0.87,p < 0.001 and −0.69,p = 0.008, respectively) and lower maintenance OCS dose (Unadjusted linear regression analysis-5.29 mg, p = 0.003 and Crude Odds Ratio-1.67, p = 0.003, respectively) were observed in the HAPR-group compared to the LAPR group. Patients receiving HAPR also had less asthma exacerbations (≥1 exacerbation: 20% vs 60%,p < 0.001) and showed improvement in lung function (%predFEV 1 3.4%,p = 0.014) compared to the LAPR group, but at 12 months no differences between groups were observed. Conclusion: HAPR resulted in a larger improvement in patient outcome parameters compared to LAPR, on the long run the improvement in patient reported symptoms and lower maintenance OCS-dose persists. Underlying factors that explain this observed effect need to be investigated.

Background In patients with severe asthma, high-altitude climate treatment has been shown to improve asthma control. However, asthma symptoms and limitations may increase after finishing inpatient rehabilitation programs and returning to sea level. Objective We assessed the effectiveness of a patient-tailored, internet-based, self-management strategy in addition to usual care after finishing high-altitude climate treatment. Methods We performed a randomized controlled trial with a 1-year follow-up in patients from a high-altitude asthma center in Davos, Switzerland. At the end of a 12-week multidisciplinary rehabilitation program, 62 adults with asthma were randomized to receive either internet-based self-management support in addition to usual care (n=33) or usual care only after discharge (n=29). The endpoints were changes in asthma-related quality of life according to the Asthma Quality of Life Questionnaire (AQLQ) (a higher score is better) and asthma control according to the Asthma Control Questionnaire (ACQ) (a lower score is better), with a minimally important difference of 0.5 points for both. Results Asthma-related quality of life and asthma control declined over time in the usual care strategy group, whereas there was a slower decline in the internet-based strategy group. For both endpoints, mixed-model analysis showed a significant positive effect in favor of internet-based self-management during follow-up (mean AQLQ score difference 0.39, 95% CI 0.092-0.69; P=.01 and ACQ score difference −0.50, 95% CI −0.86 to −0.15; P=.006), which was prominent among patients with uncontrolled asthma at discharge (AQLQ score difference 0.59, 95% CI 0.19-0.99; P=.003 and ACQ score difference −0.73, 95% CI −1.18 to −0.28; P=.002). Conclusions Internet-based self-management support was associated with a smaller decline in quality of life and asthma control as compared with usual care, especially in patients with lower asthma control, after completion of high-altitude climate treatment. Internet-based self-management support in adults with severe asthma seems feasible and effective to maintain quality of life and asthma control. Trial Registration The trial is registered in the Netherlands Trial Register (NTR1995).

Background: A 6-week personalized integrative multidisciplinary treatment programme (PIM) was developed for children with difficult to treat AD who appeared unresponsive to treatment according to current guidelines. Objective: The aim of the present study was to identify clinical and psychosocial characteristics that predict long-term treatment success after PIM. Methods: Treatment was considered successful when there was a 75% reduction on the Self-Administered Eczema Area and Severity Index and/or little impact of AD on daily life, measured with the Children's Dermatology Life Quality Index (score ≤ 6), 6 months after the end of PIM. PIM is a personalized, integrative, multidisciplinary treatment programme with clearly defined goals and strategies, addressing atopic, paediatric, mental health comorbidities and general well-being, for children and adolescents aged 8- to 18 years. Multivariate logistic regression models were constructed using a backward selection procedure. Questionnaires were used to assess psychosocial characteristics; clinical data was extracted from medical records. Results: In total, 79 children/adolescents with difficult to treat AD completed PIM and long-term treatment results were available for 74 children/adolescents. The majority (77%) of children/adolescents demonstrated long-term treatment success with PIM. Predictors of long-term treatment success (adjusted ORs) included maternal disease acceptance OR (95% CI) 1.84 (1.15–2.94). A group (23%) of mostly females OR (95% CI) 0.10 (0.02–0.54) with multiple somatic complaints OR (95% CI) 0.88(0.80–0.97), from families where the mother has anxiety for the use of topical corticosteroids OR (95% CI) 0.62(0.40–0.94), is less likely to obtain long-term treatment success. Conclusion: Most children and adolescents with difficult to treat AD, seemingly unresponsive to conventional treatment according to current guidelines, are able to improve with PIM. Psychosocial and family but not clinical variables, predicted long-term treatment success after participating in PIM.

Background About 30% of stroke patients suffer from aphasia. As aphasia strongly affects daily life, most patients request a prediction of outcome of their language function. Prognostic models provide predictions of outcome, but external validation is essential before models can be used in clinical practice. We aim to externally validate the prognostic model from the Sequential Prognostic Evaluation of Aphasia after stroKe (SPEAK-model) for predicting the long-term outcome of aphasia caused by stroke. Methods We used data from the Rotterdam Aphasia Therapy Study – 3 (RATS-3), a multicenter RCT with inclusion criteria similar to SPEAK, an observational prospective study. Baseline assessment in SPEAK was four days after stroke and in RATS-3 eight days. Outcome of the SPEAK-model was the Aphasia Severity Rating Scale (ASRS) at 1 year, dichotomized into good (ASRS-score of 4 or 5) and poor outcome (ASRS-score

Little is known about the characteristics and treatments of patients with severe asthma across Europe, but both are likely to vary. This is the first study in the European Respiratory Society Severe Heterogeneous Asthma Research collaboration, Patient-centred (SHARP) Clinical Research Collaboration and it is designed to explore these variations. Therefore, we aimed to compare characteristics of patients in European severe asthma registries and treatments before starting biologicals.This was a cross-sectional retrospective analysis of aggregated data from 11 national severe asthma registries that joined SHARP with established patient databases.Analysis of data from 3236 patients showed many differences in characteristics and lifestyle factors. Current smokers ranged from 0% (Poland and Sweden) to 9.5% (Belgium), mean body mass index ranged from 26.2 (Italy) to 30.6 kg·m−2 (the UK) and the largest difference in mean pre-bronchodilator forced expiratory volume in 1 s % predicted was 20.9% (the Netherlands versus Hungary). Before starting biologicals patients were treated differently between countries: mean inhaled corticosteroid dose ranged from 700 to 1335 µg·day−1 between those from Slovenia versus Poland when starting anti-interleukin (IL)-5 antibody and from 772 to 1344 µg·day−1 in those starting anti-IgE (Slovenia versus Spain). Maintenance oral corticosteroid use ranged from 21.0% (Belgium) to 63.0% (Sweden) and from 9.1% (Denmark) to 56.1% (the UK) in patients starting anti-IL-5 and anti-IgE, respectively.The severe asthmatic population in Europe is heterogeneous and differs in both clinical characteristics and treatment, often appearing not to comply with the current European Respiratory Society/American Thoracic Society guidelines definition of severe asthma. Treatment regimens before starting biologicals were different from inclusion criteria in clinical trials and varied between countries.

BACKGROUND: Alpine climate treatment has historically been used in Europe to treat atopic dermatitis (AD), but no randomized trials have been conducted to provide evidence for its effectiveness. OBJECTIVE: To investigate the long-term effectiveness of alpine climate treatment for children with difficult to treat AD. MATERIALS & METHODS: A pragmatic, open, randomized controlled trial was conducted. Children diagnosed with AD that was considered difficult to treat, aged between 8 and 18 years and willing to be treated in Switzerland were randomized to a six week personalized integrative multidisciplinary treatment period in a clinical setting in the alpine climate (Switzerland) or an outpatient setting in moderate maritime climate (Netherlands). Study assessments were conducted at the Wilhelmina Children's Hospital; an electronic portal was used for the collection of questionnaire data. Primary outcomes were disease activity (SAEASI), quality of life (CDLQI), and catastrophizing thoughts (JUCKKI/JU) six months after intervention. Other assessments were immediately and six weeks after intervention. Subgroup analyses concerned asthma-related outcomes. Children were randomly assigned to either the intervention or control group using a covariate adaptive randomization method, taking age and asthma diagnosis into account. Children, parents, and health care professionals involved in treatment were not blinded to group assignment. Data were analyzed according to intention-to-treat with linear mixed effects models for continuous outcomes. The trial is registered at Current Controlled Trials ISCRTN88136485. RESULTS: Between September 14th 2010 and September 30th 2014, 88 children were enrolled in the trial, 84 children were randomized (41 assigned to intervention, 43 to control) of whom 77 completed the intervention (38/41 (93%) intervention, 39/43 (91%) control) and 74 completed follow-up (38/41 (93%) intervention, 36/43 (84%) control). Six months after intervention there were no significant differences between the groups on disease activity (SAEASI mean difference -3.4 (95%CI -8.5 to 1.7)), quality of life (CDLQI mean difference -0.3 (95%CI -2.0 to 1.4)), and catastrophizing thoughts (JUCCKI/JU subscale mean difference -0.7 (95%CI -1.4 to -0.0)). Immediately and six weeks after intervention, disease activity and quality of life were significantly different in favor of alpine climate treatment. Mean differences on SAEASI were -10.1 (95%CI -14.5 to -5.8) and -8.4 (95%CI -12.2 to -4.6) and on CDLQI -1.9 (95%CI -3.3 to -0.5) and -1.5 (95%CI -2.8 to -0.3) immediately and six weeks after the intervention, respectively. There were no long-term differences on asthma related outcomes. Five serious adverse events occurred during the study period, which were not thought to be related to the treatment. CONCLUSIONS & CLINICAL RELEVANCE: For children with difficult to treat AD, there was no additional long-term benefit of alpine climate treatment, in contrast to the short-term, compared to an outpatient treatment program in moderate maritime climate, using a personalized integrative multidisciplinary treatment approach. This article is protected by copyright. All rights reserved.

Introduction One third of patients with acute stroke have aphasia. The majority receive speech and language therapy. There is evidence for a beneficial effect of speech and language therapy on restoring communication, but it is unknown whether and how efficacy of speech and language therapy is influenced by timing of treatment. We studied whether speech and language therapy early after stroke by way of intensive cognitive-linguistic treatment is more effective than no speech and language therapy in the Rotterdam Aphasia Therapy Study-3, a multicentre randomised single-blind trial. Methods and patients Stroke patients with first-ever aphasia were randomised within 2 weeks of onset to either 4 weeks of early intensive cognitive-linguistic treatment (1 h/day) or no language treatment. Hereafter, both groups received regular speech and language therapy. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test, measuring everyday verbal communication, 4 weeks after randomisation. Secondary outcomes were Amsterdam-Nijmegen Everyday Language Test at 3 and 6 months. The study was powered to detect a clinically relevant difference of four points on the Amsterdam-Nijmegen Everyday Language Test. Results Of the 152 included patients, 80 patients were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 h. The adjusted difference between groups in mean Amsterdam-Nijmegen Everyday Language Test-scores 4 weeks after randomisation was 0.39, 95% confidence interval: [−2.70 to 3.47], p = 0.805. No statistically significant differences were found at 3 and 6 months after randomisation either. Conclusion Four weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early cognitive-linguistic treatment on everyday language.

New consent management platforms (CMPs) have been introduced to the web to conform with the EU's General Data Protection Regulation, particularly its requirements for consent when companies collect and process users' personal data. This work analyses how the most prevalent CMP designs affect people's consent choices. We scraped the designs of the five most popular CMPs on the top 10,000 websites in the UK (n=680). We found that dark patterns and implied consent are ubiquitous; only 11.8% meet the minimal requirements that we set based on European law. Second, we conducted a field experiment with 40 participants to investigate how the eight most common designs affect consent choices. We found that notification style (banner or barrier) has no effect; removing the opt-out button from the first page increases consent by 22--23 percentage points; and providing more granular controls on the first page decreases consent by 8--20 percentage points. This study provides an empirical basis for the necessary regulatory action to enforce the GDPR, in particular the possibility of focusing on the centralised, third-party CMP services as an effective way to increase compliance., 13 pages, 3 figures. To appear in the Proceedings of CHI '20 CHI Conference on Human Factors in Computing Systems, April 25--30, 2020, Honolulu, HI, USA

The popularity of computational notebooks heralds a return of software as computational media rather than turn-key applications. We believe this software model has potential beyond supporting just the computationally literate. We studied a biomolecular nano-design lab that works on a current frontier of science - RNA origami - whose researchers depend on computational tools to do their work, yet are not trained as programmers. Using a participatory design process, we developed a computational labbook to concretise what computational media could look like, using the principles of computability, malleability, shareability, and distributability suggested by previous work. We used this prototype to co-reflect with the nanoscientists about how it could transform their practice. We report on the computational culture specific to this research area; the scientists' struggles managing their computational environments; and their subsequent disempowerment yet dependence. Lastly, we discuss the generative potential and limitations of the four design principles for the future of computational media.

Background: In severe asthma, it has been shown that HACT improves asthma control. However, asthma may worsen after finishing HACT and returning to sea level. We assessed the effectiveness of patient tailored eHealth self-management support in addition to standard care after discharge from HACT. Methods: In a RCT with 1-year follow-up 62 asthmatic adults were randomised to receive either eHealth self-management support (PatientCoach) in addition to standard care (N=33), or standard care only (N=29) after discharge from a 12-week multi-disciplinary rehabilitation program at a high-altitude asthma centre. Endpoints were changes in asthma-related quality of life (QoL: AQLQ, the higher the better) and asthma control (ACQ, the lower the better), both with a minimally important difference of 0.5 points. Results: Asthma-related QoL and asthma control gradually declined over time in the standard care group, whereas there was less decline in the eHealth group. In both endpoints, mixed-model analysis showed a positive effect in favour of eHealth during follow-up (AQLQ difference 0.39 (0.092 to 0.69); P = .01; ACQ difference -0.50 (-0.86 to -0.15); P = .006), which was especially found in patients with uncontrolled asthma at discharge (AQLQ difference 0.59 (0.19 to 0.99); P = .003; ACQ difference -0.73 (-1.18 to -0.28), P = .002). Conclusion: eHealth self-management support was associated with a smaller gradual decline in QoL and asthma control, especially in patients with suboptimal asthma control after discharge from HACT. eHealth support of adults with severe asthma after discharge from HACT seems feasible and effective to maintain quality of life and asthma control.

BackgroundThe demand for support for persons with mild intellectual disability or borderline intellectual functioning is growing rapidly. These persons often encounter individual and familial limitations that influence their human functioning, and often have difficulty coping with the demands of modern society. Although in the areas of policy, research and practice, people with mild intellectual disability or borderline intellectual functioning are generally approached as one group, important differences between them have been reported. Current support seems to be both suboptimal and insufficiently differentiated.MethodsIn this Delphi study we aimed to explore the need for appropriate and differentiated support for individuals with mild intellectual disability or borderline intellectual functioning. The study was based on five unique profiles of persons with mild intellectual disability or borderline intellectual functioning that are associated with individual and environmental variables. The opinions of expert primary caregivers, professional caregivers and scientists were analysed for potentially appropriate types of support for each of the five profiles.ResultsA total of 174 statements, divided over the five profiles, were presented to the participants. For 74 statements, consensus was reached between the expert groups. For each profile, these consensual statements represented specific items (e.g. concrete personal goals) and non-specific items (e.g. the attitude towards persons with mild intellectual disability or borderline intellectual functioning, and the coordination of health care) related to the support needs.ConclusionThis Delphi-based study generated consensual opinions contributing to a more differentiated system of support for individuals with mild intellectual disability or borderline intellectual functioning. Although these findings need additional investigation, they address actions that might enhance the support programmes for these individuals into more personalized support.

Mass spectrometry was used to study blood samples from patients with amyotrophic lateral sclerosis (ALS) and healthy controls. Addenbrooke's cognitive examination-III (ACE-III) was used to test for cognitive impairment (CI). Nano liquid chromatography and time of flight mass spectrometry (MS) were performed on samples from 42 ALS patients and 18 healthy controls. SWATH™ proteomic analysis was utilized to look for differences between groups. Western blot analysis was used to study levels of 4 proteins, selected as being of possible interest in ALS, in the MS discovery cohort and a second validation group of 10 ALS patients and 10 healthy controls. INGENUITY PATHWAY ANALYSIS (IPA) was applied to the final proteomic data. Between ALS patients and controls, there were significant differences in the expression of 30 proteins. Between controls and ALS patients without CI, there were significant differences in 15 proteins. Between controls and ALS patients with CI, there were significant differences in 32 proteins. Changes in levels of gelsolin, clusterin, and CD5L were validated by using western blot analysis in the discovery cohort. Changes in the expression of gelsolin, clusterin, and ficolin 3 were replicated in a validation group. In ALS, the LXR/RXR and coagulation pathways were downregulated whereas the complement pathway was upregulated. The proteomic data were used to produce two new networks, centered on IL1 and on NFkB, which showed altered levels in ALS. This study highlights the usefulness of MS of blood samples as a tool to study ALS.

Application-centric computing dominates human-computer interactions, yet the concept of an application is ambiguous and the impact of its ubiquity underexplored. We unpack "the application" through the lens of non-standard knowledge work: freelance, self-employed, and fixed-term contract workers who create knowledge in collaboration with a wide variety of stakeholders on a per-project basis. Based on interviews with fourteen participants we describe how: i) their economic value is intertwined with data and skills related to specific applications; ii) their access to this value is systematically jeopardised in collaboration due to the different application practices, preferences, and proficiencies of other stakeholders; and iii) they mitigate the costs of this compromise through cross-application collaboration strategies. We trace these experiences to common characteristics of applications, such as update processes, interface symmetries, application-document relationships, and operating system and hardware dependencies. By empirically and analytically focusing on "the application", we reveal the implications of the current application-centric computing paradigm and discuss how variations within this model create qualitatively different human-computer interactions.

Aphasia due to stroke affects communication and quality of life. Most stroke survivors with aphasia receive speech and language therapy. Although an early start of treatment is advocated in clinical practice, evidence for "The earlier, the better" in aphasia rehabilitation is weak. Hence, clinicians are faced with the dilemma of when to initiate intensive treatment: as early as possible, when most of the spontaneous recovery occurs but when patients are often ill, or later, when the patients' condition is more stabilized. Here we discuss whether aphasia outcome is affected by timing of treatment in relation to stroke onset and whether there is evidence for an optimal window of time during which language therapy should be provided. Findings from various rehabilitation research fields are discussed and combined to provide principles for future research.

Background: In patients with difficult to treat asthma, pulmonary rehabilitation has shown to improve asthma control. We assessed the effectiveness of patient tailored web-based self-management support (SMS) in addition to standard care in patients with difficult to treat asthma who have finished pulmonary rehabilitation in a specialized asthma clinic. Methods: Sixty-three asthmatic adults were randomized to receive SMS in addition to standard care with one-year follow up. Outcome measures were quality of life (QoL) and asthma control. Results: Decline of asthma-related quality of life and asthma control was better preserved in the intervention group compared to the standard care group (Fig 1). Particularly in patients with severe uncontrolled asthma at start of the rehabilitation, the decline in quality of life was relatively smaller in the web-based care group as compared to the standard care group (mean between group diff. AQLQ score (95% CI) 0.59 (0.19 to 0.99); p=0.003). Conclusion: SMS for patients with difficult to treat asthma after rehabilitation, was associated with smaller decline in QoL and asthma control, specifically in patients with uncontrolled asthma.

Background and Purpose— Nonlacunar cerebral infarcts are presumed to be caused by thromboembolism from the heart or extracranial arteries, whereas lacunar infarcts are thought to be caused by small vessel disease. We investigated to what extent arterial calcifications differ between nonlacunar and lacunar ischemic strokes. Methods— We studied 820 consecutive patients with transient ischemic attack or ischemic stroke in the anterior circulation who underwent multidetector computed tomography angiography and had no rare cause of stroke. The presence of likely cardioembolic pathogenesis was determined according to the Trial of Org 10172 in Acute Stroke Treatment criteria. The remaining 708 patients were categorized as nonlacunar or lacunar strokes, either transient ischemic attacks or strokes, based on clinical symptoms corrected by brain imaging results. We measured volume of calcifications in the aortic arch, symptomatic extracranial and intracranial carotid artery using multidetector computed tomography angiography. The difference in calcifications between nonlacunar and lacunar strokes was assessed with a multivariable logistic regression analysis. We adjusted for degree of symptomatic carotid artery stenosis and cardiovascular risk factors. Results— We found an independent association between volume of aortic arch calcifications and nonlacunar ischemic strokes (adjusted odds ratio [95% confidence interval], 1.11 [1.02–1.21]). No independent associations between extracranial and intracranial carotid artery calcifications and nonlacunar strokes were present. Conclusions— The only difference we found between nonlacunar and lacunar strokes was a higher calcification volume in the aortic arch in nonlacunar strokes. Our findings only partially confirm the notion of distinct etiologies and suggest that the potential role of other plaque components, plaque morphology, and aortic arch calcifications in ischemic stroke subtypes awaits further evaluation.

Increasing evidence suggests that patients with asthma have activated coagulation within the airways. Whether this leads to an increase in venous thromboembolic events is unknown. We therefore assessed the incidence of venous thromboembolic events in patients with mild-to-moderate and severe asthma as compared with an age- and sex-matched reference population. 648 patients with asthma (283 with severe and 365 patients with mild-to-moderate asthma) visiting three Dutch outpatient asthma clinics were studied. All patients completed a questionnaire about a diagnosis of deep vein thrombosis and pulmonary embolism in the past, their risk factors, history of asthma and medication use. All venous thromboembolic events were objectively verified. In total, 35 venous thromboembolic events (16 deep vein thrombosis and 19 pulmonary embolism) occurred at a median age of 39 (range 20-63) years. The incidence of pulmonary embolism in patients with severe asthma was 0.93 (95% CI 0.42-1.44) per 1000 person-years, 0.33 (95% CI 0.07-0.60) in mild-to-moderate asthma and 0.18 (95% CI 0.03-0.33) in the general population, respectively. Severe asthma and oral corticosteroid use were independent risk factors of pulmonary embolism (hazard ratios 3.33 (1.16-9.93) and 2.82 (1.09-7.30), respectively). Asthma was not associated with deep vein thrombosis. Severe asthma greatly enhances the risk of pulmonary embolism, particularly if chronic corticosteroids are used. Copyright ©ERS 2013.

Background Musculoskeletal disorders are a major health problem resulting in negative effects on wellbeing and substantial costs to society. Work participation is associated with positive benefits for both mental and physical health. Potentially, generalist physical therapists (GPTs) can play an important role in reducing absenteeism, presenteeism and associated costs in patients with musculoskeletal disorders. However, work participation is often insufficiently addressed within generalist physical therapy practice (GPTP). Therefore, this study evaluates whether GPTs take work participation into account as a determining factor in patients with musculoskeletal disorders, and how this might be improved. Methods This qualitative study consisted of seven focus groups involving 30 participants: 21 GPTs and 9 occupational physical therapists (OPTs). Based on an interview guide, participants were asked how they integrate work participation within their practice, how they collaborate with other professionals, and how GPTs can improve integration of the patient’s work within their practice. Results Although participants recognized the importance of work participation, they mentioned that the integration of this item in their GPTP could be improved. Generally, GPTs place insufficient priority on work participation. Moreover, there is a lack of cooperation between the generalist physical therapist and (other) occupational healthcare providers (including OPTs), and the borderlines/differences between generalist physcial therapy and occupational health physcial therapy were sometimes unclear. GPTs showed a lack of knowledge and a need for additional information about several important work-related factors (e.g. work content, physical and psychosocial working conditions, terms of employment). Conclusions Although a patient’s work is important, GPTs take insufficient account of work participation as a determining factor in the treatment of patients with musculoskeletal disorders. GPTs often lack specific knowledge about work-related factors, and there is insufficient cooperation between OPTs and other occupational healthcare providers. The integration of work participation within GPTP, and the cooperation between GPTs and other occupational healthcare providers, show room for improvement. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1546-9) contains supplementary material, which is available to authorized users.

Water reduction techniques were applied in the openhole gravel pack (OHGP) completions of four wells in Field C. Field C is operated by BP Trinidad and Tobago LLC (bpTT) and is located offshore Trinidad in the Columbus Basin. During the first phase of field development, six wells encountered economically recoverable reserves and first gas was achieved in 2007. The field produced at peak rates from December 2009 to April 2011. Between October 2010 and March 2013, four wells became liquid loaded due to aquifer influx, and production declined by ~ 80%. The second phase of field development was scheduled to commence in 2016, and hence the bpTT field team began to investigate ways to revive the four liquid loaded wells and return them to production. Using experiences from BP Global Operations, and based on the assumption that the reservoir drive mechanism was bottom and/or edge water drive, the team decided to install zonal isolation devices. Also known as water shut off plugs; these devices are usually used in oil well casing applications and had never before been tested in gas well openhole gravel packs in Trinidad and Tobago. Each plug was set within an interbedded shale in the reservoir and screen joint of the completion to provide a vertical flow barrier. Due to uncertainty on the lateral extent of the shale and its ability to act as a barrier to water encroachment, an additional step of dynamic wellbore modelling was implemented. This was used to modify well bean up in order to minimize drawdown while maintaining the critical rate. The well intervention campaign to install the plugs began in December 2013 and was executed using both slickline and e-line tools. One of the key considerations during job execution was depth control, to prevent setting the plugs too high in the wellbore and isolating gas bearing sands. This was achieved by correlating the gamma ray (GR) and Casing Collar Locator (CCL) logs with the original openhole logs. The plugs were installed by July 2014 and 75% of the wells were successfully offloaded with an average reduced WGR of 40%. This prolonged the producing life of the wells and improved the recovery factor by an average of 2%.

The beneficial effects of high-altitude treatment in asthma have been attributed to allergen avoidance. Recent evidence shows that this treatment also improves airway inflammation in nonallergic patients. We hypothesised that high-altitude treatment is clinically equally effective in patients with severe refractory asthma, with or without allergic sensitisation. In a prospective observational cohort study, 137 adults with severe refractory asthma (92 with allergic sensitisation), referred for high-altitude (1,600 m) treatment in Davos, Switzerland, were consecutively included. We measured asthma control (Asthma Control Questionnaire (ACQ)), asthma-related quality of life (Asthma-Related Quality of Life Questionnaire (AQLQ)), sino-nasal symptoms (Sino-Nasal Outcome Test (SNOT-20)), medication requirement, postbronchodilator (post-BD) forced expiratory volume in 1 s (FEV(1)), 6-min walking distance (6MWD), total immunoglobulin (Ig)E, blood eosinophils and exhaled nitric oxide fraction (F(eNO)) at admission and after 12 weeks. Sensitised and nonsensitised patients showed similar improvements in ACQ (-1.4 and -1.5, respectively; p = 0.79), AQLQ (1.6 and 1.5, respectively; p = 0.94), SNOT-20 (-0.7 and -0.5, respectively; p = 0.18), post-BD FEV(1) (6.1% and 5.8% pred, respectively; p = 0.87), 6MWD (+125 m and +147 m, respectively; p = 0.43) and oral steroids (40% versus 44%, respectively; p = 0.51). Sensitised patients showed a larger decrease in total IgE, blood eosinophils and F(eNO). High-altitude treatment improves clinical and functional parameters, and decreases oral corticosteroid requirement in patients with severe refractory asthma, irrespective of allergic sensitisation.

High-altitude treatment has been applied for more than a century in the treatment of pulmonary diseases including asthma. Many uncontrolled and controlled studies have shown its beneficial effects in children and adolescents with house dust mite allergic asthma. A recent study also showed an improvement in markers of airway inflammation in adult patients with severe intrinsic asthma, suggesting that factors other than HDM avoidance may contribute to the beneficial influence of the high-altitude climate therapy on asthma. The dry mountain climate not only has decreased levels of mite allergens but also decreased levels of pollens, fungal spores and air pollution, as well as high exposure to UV light with immunomodulatory and anti-inflammatory effects. Treatments targeting environmental control have never been investigated systematically in severe asthma, which is surprising, as environmental factors have been recognized as important contributors to asthma severity for many years and more evidence has been accumulating ever since. Preliminary evidence shows the beneficial effects of high-altitude treatment in patients with severe refractory asthma on symptoms, lung function and oral corticosteroid requirement, irrespective of atopic status. In this narrative review, we will discuss why high-altitude treatment might be a promising therapeutic option for patients who suffer from this disabling disease.

In the Netherlands, pregnant women at low risk of complications during pregnancy, have the opportunity to choose freely between giving birth at home or in a hospital maternity unit. This study analyses how various attributes of obstetric care, socio-economic characteristics and attitudes influence the decisions that these women make with regard to obstetric care. The method of discrete-choice experiment was applied in the process of data collection and analysis. The data were collected among low-risk nulliparous pregnant women. The analysis suggests that there are strong preferences among some Dutch women for a home birth. Nevertheless, the absence of a medical pain-relief treatment during home birth, might provide incentives for some women to opt for a birth in a hospital, especially at the end of their pregnancy. If the attractiveness of home birth should be preserved in the Netherlands, specific attention should be paid on the approach to pain during a home birth. Efforts could also be made in offering a domestic atmosphere during hospital births to improve hospital-based obstetric care in view of women's preferences.

Aphasia has a large impact on the quality of life and adds significantly to the costs of stroke care. Early recognition of aphasia in stroke patients is important for prognostication and well-timed treatment planning. We aimed to identify available screening tests for differentiating between aphasic and non-aphasic stroke patients, and to evaluate test accuracy, reliability, and feasibility. We searched PubMed, EMbase, Web of Science, and PsycINFO for published studies on screening tests aimed at assessing aphasia in stroke patients. The reference lists of the selected articles were scanned, and several experts were contacted to detect additional references. Of each screening test, we estimated the sensitivity, specificity, likelihood ratio of a positive test, likelihood ratio of a negative test, and diagnostic odds ratio (DOR), and rated the degree of bias of the validation method. We included ten studies evaluating eight screening tests. There was a large variation across studies regarding sample size, patient characteristics, and reference tests used for validation. Many papers failed to report on the consecutiveness of patient inclusion, time between aphasia onset and administration of the screening test, and blinding. Of the three studies that were rated as having an intermediate or low risk of bias, the DOR was highest for the Language Screening Test and ScreeLing. Several screening tools for aphasia in stroke are available, but many tests have not been verified properly. Methodologically sound validation studies of aphasia screening tests are needed to determine their usefulness in clinical practice.

Contains fulltext : 172445.pdf (Publisher’s version ) (Open Access) BACKGROUND: This study aimed to document the variation in technical efficiency of primary care (PC) practices in delivering evidence-based cardiovascular risk management (CVRM) and to identify associated factors. METHODS: This observational study was based on the follow-up measurements in a cluster randomized trial. Patients were recruited from 41 general practices in the Netherlands, involving 106 GPs and 1671 patients. Data on clinical performance were collected from patient records. The analysis focused on PC practices and used a two-stage data envelopment analysis (DEA) approach. Bias-corrected DEA technical efficiency scores for each PC practice were generated, followed by regression analysis with practice efficiency as outcomes and organizational features of general practice as predictors. RESULTS: Not all PC practices delivered recommended CVRM with the same technical efficiency; a significant difference from the efficient frontier was found (p < .000; 95 % CI 1.018-1.041). The variation in technical efficiency between PC practices was associated with training practice status (p = .026). Whether CVRM clinical tasks were performed by a practice nurse or a GP did not influence technical efficiency in a statistical significant way neither did practice size. CONCLUSIONS: Technical efficiency in delivering evidence-based CVRM increased with having a training practice status. Nurse involvement and practice size showed no statistical impact.

patient'spatient'sviewof outcome inpulmonary rehabilitation 14557.11 Abstract Purpose:Purpose:Assessmentofthepatient'sviewofoutcomeshouldcomplementstandardizedevaluationnmethods,especiall yi nmultiinterventio nrehabilitationprogrammes.Assessmentoffindividualizedoutcomeshasnotbeenusedpreviouslyinpulmonaryrehabilitationstudies..Thereforew edevelopedamethodforassessingth epatient'sviewofoutcome.Methods:Methods:Patientsandtheirtherapistsscoredthesubjectiveattainmentlevelofindividualizeddtreatmentgoalsonasixpointresponsescale.Meanattainmentscores,sensitivityyt ochange,reliabilityandvaliditywerecomputed.Results:Results:79patients(20wit hasthmaand59withchronicobstructivepulmonarydisease)whooparticipatedi na ninpatien tpulmonaryrehabilitationprogramhad54 0treatmen tgoals(rangee21 2goalsperpatient).Thepatientshadasignificantlyhighermedianattainmentscoreetha nth emaintherapists(5versus4 ,n = 286 ,p

Background Anti-allergic mattress encasing may provide clinical benefit in asthmatic patients. However, the effect of mattress encasings on allergen-specific parameters, such as bronchial reactions to house dust mite (HDM) challenge, is not clear. Objective To investigate the effect of anti-allergic mattress encasings on allergen sensitivity in patients with moderate to severe asthma. Methods Twenty-seven patients with asthma and HDM allergy were studied in a double-blind, placebo-controlled study. Concentrations of Dermatophagoides pteronyssinus (Der p 1) were measured in mattress dust before and after 1 year of treatment; bronchial histamine challenge, bronchial challenge with HDM and intradermal skin challenges with HDM were performed. The number of eosinophils in peripheral blood was assessed. Results In the active group, but not in the placebo group, there was a significant reduction in Der p 1 concentration in the dust collected from the mattresses after 1 year of treatment compared to before. There was a significant difference between the groups with respect to HDM-induced early-reaction (ER) in the airways and the number of blood eosinophils, which reflected an increase in ER and eosinophils in the placebo group without significant change in the active group. No significant improvement in PC20 histamine, late-reaction (LR) and skin tests was found in either groups. Conclusion Our data suggest that encasings protect against a further increase in allergen sensitivity in asthmatic patients, so their use should be recommended.

Background Practice accreditation is a widely used method to assess and improve the quality of healthcare services. In the Netherlands, a practice accreditation program was implemented in primary medical care. We aimed to identify determinants of impact of a practice accreditation program, building on the experiences of primary care professionals who had participated in this program. Methods An interview study was done to document the experiences of 33 participating primary care professionals and used to identify determinants of outcomes. The Consolidated Framework for Implementation Research (CFIR) was used as framework for the qualitative analysis. Results After analyzing 23 interviews saturation was reached. The practice accreditation program is based on structured quality improvement, but only some of its elements were identified as determinants of impact. Factors that were perceived to facilitate implementation of the program were: designating one person responsible for the program, ensuring clear lines of communication within the whole practice team and having affinity with or stimulate enthusiasm for improving quality of care. Contextual factors such as participation in a care group and being connected to the GP educational institute were important for actual change. The accreditation program was perceived to have positive effects on team climate and commitment to quality of care in the practice team. The perception was that patient care was not directly influenced by the accreditation program. Receiving a certificate for completing the accreditation program seemed to have little added value to participants. Conclusions Practice accreditation may have positive outcomes on quality of care, but not all planned elements may contribute to its outcomes. Both factors in the accreditation process and in the context were perceived as determinants of quality improvement. The challenge is to build on facilitating factors, while reducing the elements of accreditation that do not contribute to its impact. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0294-x) contains supplementary material, which is available to authorized users.

Background: About 10 to 20% of children in West European countries have atopic dermatitis (AD), often as part of the atopic syndrome. The full atopic syndrome also consists of allergic asthma, allergic rhinitis and food allergy. Treatment approaches for atopic dermatitis and asthma include intermittent anti-inflammatory therapy with corticosteroids, health education and self-management training. However, symptoms persist in a subgroup of patients. Several observational studies have shown significant improvement in clinical symptoms in children and adults with atopic dermatitis or asthma after treatment at high altitude, but evidence on the efficacy when compared to treatment at sea level is still lacking.Methods/Design: This study is a pragmatic randomized controlled trial for children with moderate to severe AD within the atopic syndrome. Patients are eligible for enrolment in the study if they are: diagnosed with moderate to severe AD within the atopic syndrome, aged between 8 and 18 years, fluent in the Dutch language, have internet access at home, able to use the digital patient system Digital Eczema Center Utrecht (DECU), willing and able to stay in Davos for a six week treatment period. All data are collected at the Wilhelmina Children's Hospital and DECU. Patients are randomized over two groups. The first group receives multidisciplinary inpatient treatment during six weeks at the Dutch Asthma Center in Davos, Switzerland. The second group receives multidisciplinary treatment during six weeks at the outpatient clinic of the Wilhelmina Children's Hospital, Utrecht, the Netherlands. The trial is not conducted as a blind trial. The trial is designed with three components: psychosocial, clinical and translational. Primary outcomes are coping with itch, quality of life and disease activity. Secondary outcomes include asthma control, medication use, parental quality of life, social and emotional wellbeing of the child and translational parameters.Discussion: The results of this trial will provide evidence for the efficacy of high altitude treatment compared to treatment at sea level for children with moderate to severe AD.Trial Registration: Current Controlled Trials ISRCTN88136485. © 2014 Fieten et al.; licensee BioMed Central Ltd.

Functional exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) is often assessed by the 6-min walking test (6MWT). To assess if the use of multiple factors adds to walking distance in describing performance in the 6MWT, an exploratory factor analysis was performed on physiological measurements and dyspnea ratings recorded during testing. Eighty-three patients with mild to severe COPD performed repeated 6MWTs before inpatient pulmonary rehabilitation. Factor analysis on 15 variables yielded a stable four-factor structure explaining 78.4% of the total variance. Recorded heart rate variables contributed to factor 1 (heart rate pattern), walking distance, heart rate increase, and decrease contributed to factor 2 (endurance capacity), oxygen desaturation variables contributed to factor 3 (impairment of oxygen transport), and dyspnea and effort variables contributed to factor 4 (perceived symptoms). Walking distance decreased in half of the 53 patients measured posttreatment, but self-perceived change in exercise tolerance improved in 84% and was explained by change in walking distance, by less desaturation, and by less dyspnea (R(2) = 0.55, p = 0.005). Qualitative analysis showed that 29 of 53 patients improved in three or four factors. Performance in the 6MWT can be described with four statistically independent and clinically interpretable factors. Because clinically relevant changes consist of more than only walking distance, assessment of functional exercise tolerance in patients with COPD improves by reporting multiple variables.

The improvement in the accessibility of government information is one of the primary goals of government information policy. The Dutch government seems to regard the Internet as an ideal vehicle for providing citizens with government information. But, despite the open and public character of the Internet, the Internet is not the only relevant technology that can improve the accessibility of government information. This article examines how the Dutch government has tried to improve accessibility in six particular cases of electronic publishing. The experiences within these cases can help to identify feasible options that governments have in dealing with these issues, especially the technological and organizational choices that governments face.

Spontaneous cough is a symptom with diffuse diagnostic significance for childhood asthma. Information on the interrelations between presence/frequency of cough and other symptoms of asthma are not available to the physician. Tracheal sounds were continuously recorded in the homes of 60 children with and 30 without asthma, at 72 and 24 h, respectively. Presence and frequency of cough and presence of wheeze were scored by trained examiners. Wheeze was used to indicate airway obstruction during hours when peak expiratory flow (PEF) values were not available. PEF and self-reported dyspnea were assessed every 4 h. Results showed that asthmatics coughed significantly more often than control subjects during exacerbations, but not during remission. The highest diagnostic sensitivity percentages of cough were 72% for wheeze and 69% for a reduction in PEF >20%. However, the diagnostic specificity was poor, 41% for wheeze and 34% for a reduction in PEF >20%. Cough and dyspnea were independent. Three children did not cough during exacerbations. Persistent, isolated cough was observed in two children. It was concluded that spontaneous cough is modestly predictive of asthmatic exacerbations, but not of a diagnosis of asthma or severity of asthma.

Background: Aphasia due to stroke is often very severe immediately after onset. However, knowledge about the impact of severity on therapeutic potential in the first months is scarce. The optimal therapeutic approach for patients with severe aphasia is still subject to debate. Aims: To explore the recovery pattern of verbal communication in stroke patients with aphasia of varying degrees of severity receiving language therapy during the first 6 months poststroke. Methods & Procedures: We used data from our previous trial in which 80 patients with aphasia due to stroke were randomised within the first 3 weeks postonset for either cognitive-linguistic therapy (CLT) or communicative therapy. All patients were tested at baseline and at 3 and 6 months postaphasia onset. We formed three severity groups, based on baseline Amsterdam-Nijmegen Everyday Language Test scores. We used repeated measures ANOVA to compare test scores at baseline and at 3 and 6 months poststroke onset for each of the three severity groups, stratified for the two treatments. Outcomes & Results: Patients with severe or very severe aphasia improved substantially during follow-up, especially during the first 3 months poststroke. Improvement was less pronounced in the moderate to mild group. Although improvement did not differ significantly between the two treatment arms of the trial during the first 6 months poststroke, the very severe group seemed to benefit particularly from CLT (mean difference between treatments was 4.1 points; 95% CI: -4.0 to 12.2). Conclusions: Even in very severely aphasic patients, considerable improvement of functional communication is possible. These patients might benefit more from early initiated CLT therapy than generally assumed. Hence, speech and language therapists should not refrain from applying CLT in the acute phase of rehabilitation of severe aphasia.

Item does not contain fulltext BACKGROUND: Patients with severe asthma experience problems in different areas of their health status. Identification of these areas will provide insight in the patients needs and perhaps what determines the burden of disease. The Nijmegen Clinical Screening Instrument (NCSI) was recently developed for use in clinical practice in patients with COPD and provides a detailed picture of the patients' physiological functioning, symptoms, functional impairment, and Quality of Life. Main purpose of this study is to evaluate the use of the NCSI as compared to the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ) in patients with severe asthma. METHODS: The NCSI, AQLQ, and ACQ were measured in 167 patients with severe asthma. Pearson correlations were calculated between NCSI sub-domains and the AQLQ domains and the ACQ. RESULTS: The NCSI measures more aspects of health status as compared to the ACQ and AQLQ in patients with severe asthma. Beside symptoms, subjective impairment, and emotions the NCSI also measures general Quality of Life, health related Quality of Life, satisfaction with relations, fatigue, and behavioural impairment. On all NCSI sub-domains proportions of patients with normal, mild, and severe problems were found. Heterogeneity was found on the number and on the combination of sub-domains on which patients reported severe problems. CONCLUSIONS: The NCSI provides a more detailed picture of the individual patient with severe asthma than the ACQ and AQLQ. The use of the NCSI might allow quick identification of the problem areas and possible factors that impair health status.

Electron cyclotron resonance (ECR) plasma etch processes with CHJH2/Ar have been investigated on different III-V semiconductor materials (GaAs, A1GaAs, InGaAs, and InP). The passivation depth as a function of the GaAs carrier concentration and the recovery upon annealing at different temperatures have been determined by C-V measurements. Little degradation on the characteristics of Schottky diodes is observed with increasing process biases. If the GaAs top layer of an A1GaAs/GaAs heterostructure is removed by plasma processing the Hall mobility is restored to 74% after annealing at 425~ This is compared to a wet chemically etched reference sample. The 2-DEG sheet density fully recovers. However, if an Si g-doped layer is incorporated in the heterostructure the Hall mobility and the sheet density completely restore after plasma etching and subsequent annealing. In the experiments minimal damage is observed at a substrate bias of -40 V. The direct current and high frequency characteristics of a dry and wet etched pseudomorphic heterostructure field-effect transistors are compared.

Background Cardiovascular risk management is largely provided in primary healthcare, but not all patients with established cardiovascular diseases receive preventive treatment as recommended. Accreditation of healthcare organizations has been introduced across the world with a range of aims, including the improvement of clinical processes and outcomes. The Dutch College of General Practitioners has launched a program for accreditation of primary care practices, which focuses on chronic illness care. This study aims to determine the effectiveness and efficiency of a practice accreditation program, focusing on patients with established cardiovascular diseases. Methods/design We have planned a two-arm cluster randomized trial with a block design. Seventy primary care practices will be recruited from those who volunteer to participate in the practice accreditation program. Primary care practices will be the unit of randomization. A computer list of random numbers will be generated by an independent statistician. The intervention group (n = 35 practices) will be instructed to focus improvement on cardiovascular risk management. The control group will be instructed to focus improvement on other domains in the first year of the program. Baseline and follow-up measurements at 12 months after receiving the accreditation certificate are based on a standardized version of the audit in the practice accreditation program. Primary outcomes include controlled blood pressure, serum cholesterol, and prescription of recommended preventive medication. Secondary outcomes are 15 process indicators and two outcome indicators of cardiovascular risk management, self-reported achievement of improvement goals and perceived unintended consequences. The intention to treat analysis is statistically powered to detect a difference of 10% on primary outcomes. The economic evaluation aims to determine the efficiency of the program and investigates the relationship between costs, performance indicators, and accreditation. Discussion It is important to gain more information about the effectiveness and efficiency of the practice accreditation program to assess if participation is worthwhile regarding the quality of cardiovascular risk management. The results of this study will help to develop the practice accreditation program for primary care practices. Trial registration This cluster randomized trial is registered at ClinicalTrials.gov nr NCT00791362

Eductors, also known as ejectors or jet pumps, are used to boost low pressure (LP) flows by utilizing energy from high pressure (HP) streams. An application can use gas from an HP well to boost production from an LP well. Historically, vendors only provide the performance expectations of an eductor for initial conditions. However, as reservoirs decline, the pressure and flow regimes change making the future performance of an eductor difficult to predict. In this study an eductor simulator was developed, modelling the performance from first principles rather than from generic curves. The development of the simulator tool was based on linking spreadsheets with Integrated Asset Modelling software (IAM). IAM is commonly used for reservoir, well and facility modelling, but does not cover eductors. The eductor itself was modelled in a spreadsheet. The simulator determines the eductor geometry based on the performance curves of user provided initial conditions. Subsequently, a novel nodal analysis method was used to solve the equations governing the motive and suction pressures at the entry and exit of the eductor. For each time step these solutions are transferred to a production simulator to establish pressure and rate decline. The simulator was found to predict eductor performance within ±1% of vendor provided initial time step solutions. As per real eductor performance, the simulator is limited in its capability to handle fluids. In general, the simulation results showed that application of eductors boosts production from LP wells, and increases ultimate recovery from their reservoirs, without impacting the ultimate recovery from the HP source. The simulator was used to predict the performance of two new shallow gas wells boosted by gas from a sidetracked high pressure reservoir, showing an incremental 80 billion cubic feet of gas for an investment corresponding with 10% of the cost of a new well. The simulator is now used to identify eductor related reserves adding opportunities. For the first time engineers are able to simulate the performance of a gas production boosting system, to verify options provided by vendors and to conduct economic feasibility studies with varying eductor geometries and production schedules.

We are on the threshold of a paradigm shift for proteomics, moving from largely a qualitative discipline, to now being capable of quantification of a protein within a complex sample at great sensitivity. The potential application of such advanced proteomic technology is enormous as we will be able to detect and quantify low levels of expressed proteins in complex samples, and so move comparative proteomics to a new level. The evolving practice of personalized medicine will be dependent on devising new techniques and methodologies that will allow the detection and quantification of proteins that are implicated in contributing to the diseased state. There is perhaps somewhere over 5000 genes that are linked to disease states and complex networks of interactions of these expressed genes ultimately lead to these disease states. The myriad of single nucleotide polymorphisms (SNPs) contribute to such phenomena, as an individual’s SNP profile play a major role in susceptibility to disease and in adverse reactions to drugs, for example. Coupled with mutations that occur throughout life, the complex “disease state” proteome will contain mutant proteins at low levels that need to be identified and quantified, so that therapeutic intervention based on rational scientific hypotheses can be investigated. Plasma and serum contain an unknown number of proteins with amounts ranging from pgg/L levels (i.e. very high dynamic range). As we know one of the major problems faced by proteomic studies of plasma or serum, or indeed any complex protein sample, is that a relatively small number of abundant proteins accounts for the great majority of protein content of the sample. The upshot is that the proteins of interest, which may have regulatory function, are masked by these abundant proteins, and non-targeted methods of proteomic analysis bias at the top end of the abundance scale. The development of new methods for quantifying low abundance proteins has evolved rapidly, concomitant with the evolution of powerful mass spectrometers of increasing sensitivity. The use of antibodies for targeting peptides prior to mass spectrometry analysis is becoming prominent, as a means of partitioning low abundance peptides away from peptides in the bulk sample. This review will provide a broad overview of the evolution of proteomic methods to analyse biological samples, including Differential In-Gel Electrophoresis (DIGE), Isotope-Coded Affinity Tag (ICAT), Isobaric tags for relative and absolute quantification (iTRAQ), Stable isotope labeling with amino acids in cell culture (SILAC), Unique ion signature Mass

Assessment of student learning in team-based subjects can be challenging, as the inherent complexity in this learning environment can create ambiguity for academic staff and students alike. This five-institution research project gathered data from academic staff and students about their experiences with assessment in team-based settings, data which served as a support for the development of a conceptual model for effective assessment of individual student learning in this highly collaborative setting. This paper reports on the research design of this on-going project, the conceptual assessment model, and the future directions for the project itself.

J Vet Intern Med. 2012 Nov;26(6):1274-80. doi: 10.1111/j.1939-1676.2012.01001.x. Epub 2012 Sep 24. Association of dietary copper and zinc levels with hepatic copper and zinc concentration in labrador retrievers. Fieten H, Hooijer-Nouwens BD, Biourge VC, Leegwater PA, Watson AL, van den Ingh TS, Rothuizen J. Source Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands. Abstract BACKGROUND: Copper-associated hepatitis is an inherited disease in the Labrador Retriever. Apart from genetic factors, dietary intake of copper and zinc are suspected to play a role in the pathogenesis. OBJECTIVES: To investigate whether dietary copper and zinc levels of commercially available dry diets are associated with hepatic copper and zinc concentrations in Labrador Retrievers. ANIMALS: Fifty-five Labrador Retrievers that were fed a single brand and type of commercial dry food for at least 1 year. Of these, 44 dogs were family members of Labrador Retrievers with copper-associated hepatitis. METHODS: Liver biopsies, blood samples, and diet samples were obtained. Liver specimens were scored histologically and copper and zinc concentrations were quantified. Dietary concentrations of copper and zinc were measured. The association between dietary intake of copper and zinc and hepatic copper and zinc concentrations was investigated by linear regression analysis. RESULTS: High dietary copper and low dietary zinc levels were significantly associated with high hepatic copper levels. No association between dietary intake and hepatic zinc was present. CONCLUSIONS AND CLINICAL RELEVANCE: Dietary copper and zinc at current levels in commercially available dry dog food can influence hepatic copper and can be a risk factor for the development of copper-associated hepatitis in Labrador Retrievers with a genetic susceptibility to copper. Copyright © 2012 by the American College of Veterinary Internal Medicine. PMID: 22998127 [PubMed - in process]

This chapter presents survey results of learning and teaching methodologies and assessment of Final Year Engineering Projects (FYEP) as employed across several participating institutions throughout Australia and New Zealand. As a result of preliminary dialogue with practitioners within each institution, a number of common issues and discrepancies have been revealed. These issues include a lack of transparency and consistency in the field. Report findings indicate the need to engage in further dialogue with supervisors, lecturers, and students engaged in the FYEP process to develop best practice in the FYEP paradigm.

Background: Cetirizine hydrochloride has proved effective in reducing allergic symptoms and can inhibit the infiltration of eosinophils in allergic late-phase responses in the skin. Because eosinophils are likely to play an important role in allergic late-phase reactions, we studied the effect of cetirizine on early and late asthmatic reactions and on levels of eosinophil cationic protein (ECP) in the blood after allergen challenge. Methods: The effect of 15 mg cetirizine given twice daily was studied in 16 patients allergic to house dust mites in a double-blind, placebo-controlled study. Patients were treated for 3 weeks. Before and after treatment, bronchial challenges with house-dust mites were performed. Blood ECP levels were measured 6 hours after challenge. Methacholine provocation was performed 72 hours before and 24 hours after each challenge. Results: Early and late asthmatic response—measured as mean maximal fall in forced expiratory volume in 1 second (FEV 1 ) and the provocative dose of allergen that causes a 15% fall in FEV 1 (PD 15 allergen) — were not significantly reduced after treatment with cetirizine, compared with placebo. There was also no significant effect on the concentration of methacholine, which causes a 20% fall in FEV 1 (PC 20 methacholine). The increase in the level of ECP in the blood after allergen challenge was reduced after cetirizine treatment, compared with placebo, but this difference was not statistically significant. Conclusion: Eighteen days of treatment with cetirizine did not significantly reduce the intensity of the early and late asthmatic responses.

We report the formation of site-controlled InAs quantum dots (QDs) on InP pyramids and their integration into planar structures by metalorganic vapor-phase epitaxy. The QD number is reduced by the shrinking pyramid size during growth. Finally the emission from a single QD is observed at 1.55 µm, after optimization of the growth parameters. Employing regrowth epitaxy, position-controlled InAs QDs are integrated into planar InP structures. A smooth surface morphology is obtained at 640 °C during regrowth.

Contains fulltext : 89182.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Delphi procedures are frequently used to develop performance indicators, but little is known about the validity of this method. We aimed to examine the consistency of indicator selection across different procedures and across different panels. METHODS: Analysis of three indicator set development procedures: the EPA Cardio project, which used international GP panels; the UniRap project, a Dutch GP indicator project; and the Vitale Vaten project, which used a national multidisciplinary health professional panel and a stakeholder panel. RESULTS: With respect to clinical indicators, consistency between procedures varied according to the origin of the indicators. In Vitale Vaten the multidisciplinary panel of health professionals validated 63% from the international EPA Cardio indicators again. From the UniRap GP set only 13% was rated valid again. Considering organisational indicators, 27 indicators were rated in both EPA Cardio and Vitale Vaten. In the Vitale Vaten project 17 indicators (63%) were validated, including eight of the nine indicators validated in EPA Cardio. Consistency between panels was moderate, giving a decisive role to the health professional panel, being the most critical. CONCLUSION: The consistency of selected performance indicators varied across procedures and panels. Further research is needed to identify underlying determinants of this variation. 01 oktober 2010