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A valid non-wear algorithm for activity monitors is crucial to avoid the misclassification of sedentary time as non-wear time, and vice versa. Characteristics of the algorithm, such as time windows, should be well defined and tested. Furthermore, using tri-axial data might influence the algorithm’s performance. This study assessed the optimal time window length in a non-wear algorithm for overweight adults, applied to tri-axial data from sixteen participants. Ten time windows, from 10 up to 120 min, were tested with a diary as a criterion measure. We assessed the bias in non-wear time, sensitivity and specificity. The optimal time window length was based on ten participants; the validation of this time window was carried out with six other participants. The time window of 20 min showed the highest and 120 min showed the lowest mean amount of correctly classified non-wear time, at 94% and 70% respectively. Sensitivity and specificity were considered optimal in the 20 min time window. Validation of this time window demonstrated a sensitivity and specificity of 86% and 83% respectively. A 20 min time window showed the best non-wear estimations. The current study utilized tri-axial raw data and 1 s epoch data which might have facilitated the application of a short time window and thereby decreased the risk of misclassifying non-wear. [ABSTRACT FROM AUTHOR]

BackgroundRenal microcirculation is essential for regulation of the glomerular filtration rate, the reabsorption of salt and water from the interstitium, and hence the blood pressure. Renal ultrasonography coupled to Doppler analysis and contrast-enhanced ultrasound enables the study of renal perfusion. So far, physiologic interventions have rarely been performed to assess the renal perfusion. The objective of our study was to measure the renal perfusion in response to a cold pressor test (CPT).MethodsHealthy adult participants were exposed to a 2 min CPT or a sham exposure (body temperature). Systemic hemodynamics, renal resistive index (RRI) and renal perfusion index (PI) were measured before and during the CPT or the sham exposure. Renal responses were compared using a paired Student's t-test or Wilcoxon signed rank test. Pearson correlation test was used to test association of variables of interest.ResultsForty-one normotensive participants (21 women) were included in the study. Mean blood pressure and heart rate both increased with the CPT. The RRI decreased from 0.60 ± 0.05 arbitrary units (AU) to 0.58 ± 0.05 AU (p < 0.05) and the PI increased from 2,074 AU (1,358–3,346) to 3,800 AU (2,118–6,399) (p < 0.05) (+66% (24–106%)). Compared to the sham exposure, the increase in PI with the CPT was more marked. There was a negative association between the increase in heart rate and mean blood pressure with the RRI (r: −0.550, p = 0.002 and r: −0.395, P = 0.016), respectively.ConclusionDoppler Ultrasound and CEUS enable the detection of physiological changes within the macro- and microvascular renal circulation. The CPT decreases the RRI and increases the PI. Whether these changes are present in pathological states such as diabetes or hypertension will need additional studies.

BackgroundApproximately 2% of patients in primary care practice and up to 25% of hospital patients are registered as being allergic to an antibiotic. However, up to 90% of these registrations are incorrect, leading to unnecessary prescription of 2nd choice antibiotics with the attendant loss of efficacy, increased toxicity and antibiotic resistance. To improve registration, a better understanding is needed of how incorrect labels are attributed.ObjectiveTo investigate the quality of antibiotic allergy registration in primary care and identify determinants to improve registration of antibiotic allergies.DesignRegistration of antibiotic allergies in primary care practices were analysed for 1) completeness and 2) correctness. To identify determinants for improvement, semi-structured interviews with healthcare providers from four healthcare domains were conducted.ParticipantsA total of 300 antibiotic allergy registrations were analysed for completeness and correctness. Thirty-four healthcare providers were interviewed.Main measuresA registration was defined as complete when it included a description of all symptoms, time to onset of symptoms and the duration of symptoms. It was defined as correct when the conclusion was concordant with the Salden criteria. Determinants of correct antibiotic allergy registrations were divided into facilitators or obstructers.Key resultsRates of completeness and correctness of registrations were 0% and 29.3%, respectively. The main perceived barriers for correct antibiotic allergy registration were insufficient knowledge, lack of priority, limitations of registration features in electronic medical records (EMR), fear of medical liability and patients interpreting side-effects as allergies.ConclusionsThe quality of antibiotic allergy registrations can be improved. Potential interventions include raising awareness of the consequences of incomplete and the importance of correct registrations, by continued education, and above all simplifying registration in an EMR by adequate ICT support.

Abstract Background From a stewardship perspective it is recommended that antibiotic guidelines are adjusted to the local setting, accounting for the local epidemiology of pathogens. In many settings the prevalence of Gram-negative pathogens with resistance to empiric sepsis therapy is increasing. How and when to escalate standard sepsis therapy to a reserve antimicrobial agent, is a recurrent dilemma. The study objective was to develop decision strategies for empiric sepsis therapy based on local microbiological and clinical data, and estimate the number needed to treat with a carbapenem to avoid mismatch of empiric therapy in one patient (NNTC). Methods We performed a nested case control study in patients (> 18 years) with Gram-negative bacteremia in 2013–2016. Cases were defined as patients with Gram-negative bacteremia with in vitro resistance to the combination 2nd generation cephalosporin AND aminoglycoside (C-2GC + AG). Control patients had Gram-negative bacteremia with in vitro susceptibility to cefuroxime AND/OR gentamicin, 1:2 ratio. Univariate and multivariable analysis was performed for demographic and clinical predictors of resistance. The adequacy rates of empiric therapy and the NNTC were estimated for different strategies. Results The cohort consisted of 486 episodes of Gram-negative bacteremia in 450 patients. Median age was 66 years (IQR 56–74). In vitro resistance to C-2GC + AG was present in 44 patients (8.8%). Independent predictors for resistance to empiric sepsis therapy were hematologic malignancy (adjusted OR 4.09, 95%CI 1.43–11.62, p

IntroductionModern imaging techniques such as blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) allow the non-invasive and indirect measurement of brain activity. Whether changes in signal intensity can be detected in small brainstem regions during a cold pressor test (CPT) has not been explored thoroughly. The aim of this study was to measure whole brain and brainstem BOLD signal intensity changes in response to a modified CPT.MethodsBOLD fMRI was measured in healthy normotensive participants during a randomized crossover study (modified CPT vs. control test) using ultra-high field 7 Tesla MRI scanner. Data were analyzed using Statistical Parametric Mapping (SPM) in a whole-brain approach, and with a brainstem-specific analysis using the spatially unbiased infra-tentorial template (SUIT) toolbox. Blood pressure (BP) and hormonal responses (norepinephrine and epinephrine levels) were also measured. Paired t-test statistics were used to compare conditions.ResultsEleven participants (six women, mean age 28 ± 8.9 years) were analyzed. Mean arterial BP increased from 83 ± 12 mm Hg to 87 ± 12 mm Hg (p = 0.0009) during the CPT. Whole-brain analysis revealed significant activations linked to the CPT in the right supplementary motor cortex, midcingulate (bilateral) and the right anterior insular cortex. The brainstem-specific analysis showed significant activations in the dorsal medulla.ConclusionChanges in BOLD fMRI signal intensity in brainstem regions during a CPT can be detected, and show an increased response during a cold stress in healthy volunteers. Consequently, BOLD fMRI at 7T is a promising tool to explore and acquire new insights in the comprehension of neurogenic hypertension.

One of the marvels of biology is the phenotypic plasticity of microorganisms. It allows them to maintain high growth rates across conditions. Studies suggest that cells can express metabolic enzymes at tuned concentrations through adjustment of gene expression. The associated transcription factors are often regulated by intracellular metabolites. Here we study metabolite-mediated regulation of metabolic-gene expression that maximises metabolic fluxes across conditions. We developed an adaptive control theory, qORAC (for 'Specific Flux (q) Optimization by Robust Adaptive Control'), and illustrate it with several examples of metabolic pathways. The key feature of the theory is that it does not require knowledge of the regulatory network, only of the metabolic part. We derive that maximal metabolic flux can be maintained in the face of varying N environmental parameters only if the number of transcription-factor binding metabolites is at least equal to N. The controlling circuits appear to require simple biochemical kinetics. We conclude that microorganisms likely can achieve maximal rates in metabolic pathways, in the face of environmental changes.

Healthcare providers regularly discuss the situation of a patient and his or her care needs with colleagues. This in an effort to compare experiences and provide in a coordinated way high quality care to patients. These multidisciplinary meetings are sometimes also attended by healthcare professionals that do not themselves have a treatment relation with the patient, such as medical students and junior doctors for learning purposes. This raises the question whether it is allowed for non-treating professionals to attend these meetings without the prior informed consent of the patient. We argue that the attendance on non-treating professionals is in accordance with the rules of the General Data Protection Regulation and the Dutch Act on Patients' Rights provided that they are bound by the duty of confidentiality.

This study assessed the feasibility, implementation process and outcomes of the VReedom training; a virtual reality (VR)-based intervention designed to prepare forensic psychiatric patients for their first authorized leave. Clinical forensic mental healthcare organization Inforsa, operating at security level 3, introduced the VReedom training for forensic patients eligible for their first authorized leave, between March 1st and November 13th, 2022. Employing a retrospective observational cohort study design with patient dossier data as the primary source, the study also used participant observation, weekly evaluative questionnaires and focus group discussions as data sources. Five objectives were utilized to evaluate the feasibility: recruitment capacity and resulting sample characteristics, data collection and evaluation procedures, acceptability and suitability of the training and protocol, training management and implementation, and preliminary participant results. Despite the lack of a control group, findings align with literature suggesting VR's potential for enhancing treatment motivation and reducing stress in preparation for first authorized leave. Of 13 patients approached, 10 participated without dropouts, and no incidents occurred during training. Emotion elicitation was successful, supporting VR Exposure therapy's efficacy. Findings align with literature, emphasizing VR's value in forensic psychiatry. Establishing favorable implementation conditions was crucial, with positive reception from treatment providers. Also, the need for personalization and additional locations was identified, and the training seemed most suitable for patients with a tbs-measure. Future research with control groups is recommended to further validate the effectiveness of the VReedom training intervention, and further protocol development is necessary to make it suitable for a broader population. Current findings contribute to the refinement and expansion of evidence-based practices in the field of VR-assisted training and treatment in forensic psychiatry., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hendriks, Jansen, Smit, Smulders, Popma and Van Der Pol.)

The immunosuppressive non-classical human leukocyte antigen-G (HLA-G) can elicits pro-viral activities by down-modulating immune responses. We analysed soluble forms of HLA-G, IL-6 and IL-10 as well as on immune effector cell expression of HLA-G and its cognate ILT-2 receptor in peripheral blood obtained from hospitalised and convalescent COVID-19 patients. Compared with convalescents (N = 202), circulating soluble HLA-G levels (total and vesicular-bound molecules) were significantly increased in hospitalised patients (N = 93) irrespective of the disease severity. During COVID-19, IL-6 and IL-10 levels were also elevated. Regarding the immune checkpoint expression of HLA-G/ILT-2 on peripheral immune effector cells, the frequencies of membrane-bound HLA-G on CD3+ and CD14+ cells were almost identical in patients during and post COVID-19, while the frequency of ILT-2 receptor on CD3+ and CD14+ cells was increased during acute infection. A multi-parametric correlation analysis of soluble HLA-G forms with IL-6, IL-10, activation markers CD25 and CD154, HLA-G, and ILT-2 expression on immune cells revealed a strong positive correlation of soluble HLA-G forms with membrane-bound HLA-G molecules on CD3+/CD14+ cells only in convalescents. During COVID-19, only vesicular-bound HLA-G were positively correlated with the activation marker CD25 on T cells. Thus, our data suggest that the elevated levels of soluble HLA-G in COVID-19 are due to increased expression in organ tissues other than circulating immune effector cells. The concomitant increased expression of soluble HLA-G and ILT-2 receptor frequencies supports the concept that the immune checkpoint HLA-G/ILT-2 plays a role in the immune-pathogenesis of COVID-19., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

Purpose: The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a scale to quantify the severity of pharyngeal dysphagia in head and neck cancer (HNC) patients. This study (1) described the training process of the observers for DIGEST in fiberoptic endoscopic evaluation of swallowing (FEES), (2) determined observer agreement on the DIGEST in FEES, (3) explored the effect of bolus consistency on observer agreement, and 4) explored criterion validity of the DIGEST in FEES., Methods: Twenty-seven dysphagic HNC patients were enrolled. Two observers completed a training program for DIGEST in FEES. Observer agreement on the Penetration-Aspiration Scale (PAS), percentage of pharyngeal residue (PPR), and DIGEST grades was determined using linearly weighted Cohen's kappa coefficient (κ)., Results: Due to insufficient observer agreement after the first measurement attempt, additional training was organized using an elaborated manual with descriptions of the visuoperceptual variables, thereby improving observer agreement. Intraobserver agreement was almost perfect on the PAS (κ = 0.86-0.88) and PPR (κ = 0.84-0.86). Interobserver agreement was substantial on the PAS (κ = 0.78), almost perfect on the PPR (κ = 0.82), substantial on the safety grade (κ = 0.64), almost perfect on the efficiency grade (κ = 0.85), and substantial on the summary grade (κ = 0.71). Bolus consistency had an effect on observer agreement. A significant correlation was found between DIGEST efficiency grade and EAT-10., Conclusion: The DIGEST showed to be a reproducible measurement for FEES in terms of observer agreement. However, agreement between novice observers on the DIGEST was only reached after specific observer-tailored training. Observer agreement should be analyzed by taking bolus consistency into account during training, as this might affect the interpretation of the outcome. A manual with well-defined descriptions can optimize the reproducibility of DIGEST measurements., (© 2023. The Author(s).)

This study aimed to examine the level of discrimination against people with intellectual disability during COVID-19, and assessed stereotypes, levels of familiarity with people with intellectual disability, and personal experiences with COVID-19 as potential correlates. A cross-sectional study was conducted using a large sample from the Dutch population (n = 1,797). Salient stereotype factors of people with intellectual disability were "friendly" and "in need of help," but not "give nuisance." Those respondents who were unfamiliar with people with intellectual disability in real life demonstrated higher levels of discrimination, perceiving them as more of a nuisance and as being less in need of help, in comparison to those who were more familiar. People with intellectual disability were judged by an ambivalent set of stereotypes during the COVID-19 pandemic that were in line with pre-COVID-19 findings and as such seemed to be fairly persistent and robust. There is a pressing need to both raise awareness of stereotypes towards and discrimination against people with intellectual disability via advocacy and education, and to facilitate positive encounters., (©AAIDD.)

By law hospitals are allowed to give general physicians access to the electronic medical file of a patient on the basis of the patient's consent. There are two exceptions to this general rule. Despite the fact that new national and EU legislation is on its way, the possibilities of giving more access to general physicians remain restricted. This despite the fact that hospitals, physicians and patients are generally in favour of giving general physicians more access to electronic medical files in hospitals.

Women with mental health issues may wish to get pregnant. In some situations a pregnancy is contra-indicated or not be in the best interests of the future child. This article analyses the way treating physicians may assist these women and, if needed, treat these women by using somatic of psychiatric care. This on the basis of the Dutch Patients' Rights Act and mental health legislation. The recent Dutch Mandatory Health Care Act provides physicians more opportunities to act in comparison with the previous situation.

A physician may suspect that another physician has made a medical mistake without informing the patient about this. Under Dutch law the treating physician is entitled to inform the patient about his concerns. This is, however, not a legal or professional obligation. Under Dutch law, the duty to inform a patient about mistakes rests upon the responsible health care provider. Whether the current treating physician decides to inform the patient, with or without previously contacting his or her predecessor, depends on all relevant factors.

The development of alternative in vitro culture methods has increased in the last decade as three-dimensional organoids of various tissues, including those of the small and large intestines. Due to their multicellular composition, organoids offer advantages over traditionally used immortalized or primary cell lines. However, organoids must be accurate models of their tissues of origin. This study compared gene expression profiles with respect to markers of specific cell types (stem cells, enterocytes, goblet, and enteroendocrine cells) and barrier maturation (tight junctions) of colonoid and enteroid cultures with their tissues of origin and colonoids with enteroids. Colonoids derived from three healthy pigs formed multilobed structures with a monolayer of cells similar to the crypt structures in colonic tissue. Colonoid and enteroid gene expression signatures were more similar to those found for the tissues of their origin than to each other. However, relative to their derived tissues, organoids had increased gene expression levels of stem cell markers Sox9 and Lgr5 encoding sex-determining region Y-box 9 and leucine-rich repeat-containing G protein-coupled rector 5, respectively. In contrast, expression levels of Occl and Zo1 encoding occludin and zonula occludens 1, respectively, were decreased. Expression levels of the cell lineage markers Atoh1 , Cga , and Muc2 encoding atonal homolog 1, chromogranin A, and mucin 2, respectively, were decreased in colonoids, whereas Sglt1 and Apn encoding sodium-glucose transporter 1 and aminopeptidase A, respectively, were decreased in enteroids. These results indicate colonoid and enteroid cultures were predominantly comprised of undifferentiated cell types with decreased barrier maturation relative to their tissues of origin.

The number of employees applying for a labour disability benefit due to whiplash has gradually decreased during the last 25 years in the Netherlands. The total number of applicants seems to stabilise around 30% of the number around the turn of the century. This is surprising given that the professional standards for social insurance physicians emphasise the importance of rehabilitation, while courts hardly ever judge in favour of benefit claimants. We investigate the underlying reasons for the changing statistics and make a recommendation on how social insurance physicians can best approach a claimant.

Even though family plays a significant role in the lives of people with intellectual disability, little research has included their own views about their families. This study examined how 138 people with mild intellectual disability describe their family group, with a focus on the reciprocal nature of the emotional support in relationships with family members. Participants reported "significant" family members beyond the nuclear family, and parents were seen as the main provider of support. Only half of participants had a support relationship with siblings and just 13% of participants reported partners. About 30% of support was reciprocal, and reciprocity varied greatly with the types of family connection (e.g., siblings, peers). Implications for future research as well as practice are discussed.

Background: Many malaria-endemic areas experience seasonal fluctuations in case incidence as Anopheles mosquito and Plasmodium parasite life cycles respond to changing environmental conditions. Identifying location-specific seasonality characteristics is useful for planning interventions. While most existing maps of malaria seasonality use fixed thresholds of rainfall, temperature, and/or vegetation indices to identify suitable transmission months, we construct a statistical modelling framework for characterising the seasonal patterns derived directly from monthly health facility data., Methods: With data from 2669 of the 3247 health facilities in Madagascar, a spatiotemporal regression model was used to estimate seasonal patterns across the island. In the absence of catchment population estimates or the ability to aggregate to the district level, this focused on the monthly proportions of total annual cases by health facility level. The model was informed by dynamic environmental covariates known to directly influence seasonal malaria trends. To identify operationally relevant characteristics such as the transmission start months and associated uncertainty measures, an algorithm was developed and applied to model realisations. A seasonality index was used to incorporate burden information from household prevalence surveys and summarise 'how seasonal' locations are relative to their surroundings., Results: Positive associations were detected between monthly case proportions and temporally lagged covariates of rainfall and temperature suitability. Consistent with the existing literature, model estimates indicate that while most parts of Madagascar experience peaks in malaria transmission near March-April, the eastern coast experiences an earlier peak around February. Transmission was estimated to start in southeast districts before southwest districts, suggesting that indoor residual spraying should be completed in the same order. In regions where the data suggested conflicting seasonal signals or two transmission seasons, estimates of seasonal features had larger deviations and therefore less certainty., Conclusions: Monthly health facility data can be used to establish seasonal patterns in malaria burden and augment the information provided by household prevalence surveys. The proposed modelling framework allows for evidence-based and cohesive inferences on location-specific seasonal characteristics. As health surveillance systems continue to improve, it is hoped that more of such data will be available to improve our understanding and planning of intervention strategies.

Purpose of Review: Fatigue is a problem experienced by many patients suffering from chronic diseases, including sarcoidosis patients. It has a substantial influence on patients' quality of life (QoL). It is, therefore, important to properly assess fatigue with a valid and reliable measure. The Fatigue Assessment Scale (FAS) is the only validated self-reporting instrument classifying fatigue in sarcoidosis. The aim of this review was to examine the psychometric properties of the FAS and the diseases and languages in which it has been used. Studies among sarcoidosis patients were also reviewed in terms of outcomes., Recent Findings: Studies were identified by searching the electronic bibliographic database Pubmed. Search terms used were: FAS and fatigue. Articles were included in the review if the FAS had been used to assess fatigue., Results: Since its introduction, the FAS was used in 26 different diseases or conditions, including stroke, neurologic disorders, rheumatoid arthritis, idiopathic pulmonary fibrosis and sarcoidosis. Its reliability and validity have proved to be good. Unidimensionality has been established. So far, the FAS is available in 20 languages and widely used in sarcoidosis. Digital versions as well as PDFs of various languages are available online (www.wasog.org)., Summary: The FAS has good psychometric qualities for the diseases in which it has been examined, including sarcoidosis, and can be used in clinical practice. Healthcare workers can use the FAS to assess fatigue in the management, follow-up and clinical care programmes for their patients consistently across countries, as well as in clinical research.

Background: Fatigue is a major and disabling problem in sarcoidosis. Knowledge concerning correlates of the development of fatigue and possible interrelationships is lacking., Objective: A conceptual model of fatigue was developed and tested., Methods: Sarcoidosis outpatients (n = 292) of Maastricht University Medical Center completed questionnaires regarding trait anxiety, depressive symptoms, cognitive failure, dyspnea, social support, and small fiber neuropathy (SFN) at baseline. Fatigue was assessed at 6 and 12 months. Sex, age, and time since diagnosis were taken from medical records. Pathways were estimated by means of path analyses in AMOS., Results: Everyday cognitive failure, depressive symptoms, symptoms suggestive of SFN, and dyspnea were positive predictors of fatigue. Fit indices of the model were good., Conclusions: The model validly explains variation in fatigue. Everyday cognitive failure and depressive symptoms were the most important predictors of fatigue. In addition to physical functioning, cognitive and psychological aspects should be included in the management of sarcoidosis patients., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: Apaziquone (also known as EO9 and Qapzola TM ) is a prodrug that is activated to DNA damaging species by oxidoreductases (particularly NQO1) and has the ability to kill aerobic and/or hypoxic cancer cells. Areas covered: Whilst its poor pharmacokinetic properties contributed to its failure in phase II clinical trials when administered intravenously, these properties were ideal for loco-regional therapies. Apaziquone demonstrated good anti-cancer activity against non-muscle invasive bladder cancer (NMIBC) when administered intravesically to marker lesions and was well tolerated with no systemic side effects. However, phase III clinical trials did not reach statistical significance for the primary endpoint of 2-year recurrence in apaziquone over placebo although improvements were observed. Post-hoc analysis of the combined study data did indicate a significant benefit for patients treated with apaziquone, especially when the instillation of apaziquone was given 30 min or more after surgery. A further phase III study is ongoing to test the hypotheses generated in the unsuccessful phase III studies conducted to date. Expert opinion: Because of its specific pharmacological properties, Apaziquone is excellently suited for local therapy such as NMIBC. Future studies should include proper biomarkers.

The emission of isoprene and other biogenic volatile organic compounds from vegetation plays an important role in tropospheric ozone (O3) formation. The potentially large expansion of isoprene emitting species (e.g., poplars) for bioenergy production might, therefore, impact tropospheric O3 formation. Using the eddy covariance technique we have simultaneously measured fluxes isoprene, O3 and of CO2 from a poplar (Populus) plantation grown for bioenergy production. We used the chemistry transport model LOTOS-EUROS to scale-up the isoprene emissions associated with the existing poplar plantations in Europe, and we assessed the impact of isoprene fluxes on ground level O3 concentrations. Our findings suggest that isoprene emissions from existing poplar-for-bioenergy plantations do not significantly affect the ground level of O3 concentration. Indeed the overall land in Europe covered with poplar plantations has not significantly changed over the last two decades despite policy incentives to produce bioenergy crops. The current surface area of isoprene emitting poplars-for-bioenergy remains too limited to significantly enhance O3 concentrations and thus to be considered a potential threat for air quality and human health.

The Netherlands does not have any specific legislation pertaining to human biological materials and data collection by biobanks. Instead, these issues are governed by a patchwork of laws, codes of practices, and other ethical instruments, where special emphasis is given to the right to privacy and self-determination. While draft legislation for biobanking was scheduled to enter into force in 2007, as of mid-2015 such legislation was still under consideration, with the intent that it would focus particularly on individual self-determination, the interests of research, the use of bodily materials collected by biobanks for criminal law purposes, and dilemmas around results that are clinically relevant for biobank participants. Under the current framework, the amount of privacy protection afforded to data is linked to its level of identifiability. International sharing of personal data to non-EU/European Economic Area countries is allowed if these countries provide adequate protection., (© 2016 American Society of Law, Medicine & Ethics.)

Effective air pollution and short-lived climate forcer mitigation strategies can only be designed when the effect of emission reductions on pollutant concentrations and health and ecosystem impacts are quantified. Within integrated assessment modeling source-receptor relationships (SRRs) based on chemistry transport modeling are used to this end. Currently, these SRRs are made using invariant emission time profiles. The LOTOS-EUROS model equipped with a source attribution module was used to test this assumption for renewable energy scenarios. Renewable energy availability and thereby fossil fuel back up are strongly dependent on meteorological conditions. We have used the spatially and temporally explicit energy model REMix to derive time profiles for backup power generation. These time profiles were used in LOTOS-EUROS to investigate the effect of emission timing on air pollutant concentrations and SRRs. It is found that the effectiveness of emission reduction in the power sector is significantly lower when accounting for the shift in the way emissions are divided over the year and the correlation of emissions with synoptic situations. The source receptor relationships also changed significantly. This effect was found for both primary and secondary pollutants. Our results indicate that emission timing deserves explicit attention when assessing the impacts of system changes on air quality and climate forcing from short lived substances.

There is a lack of real-time continuous beam-diagnostic tools for medical cyclotrons due to high power deposition during proton irradiation. To overcome this limitation, we have developed a profile monitor that is capable of providing continuous feedback about beam shape and current in real time while it is inserted in the beam path. This enables users to optimize the beam profile and observe fluctuations in the beam over time with periodic insertion of the monitor.