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Dynamic imaging of the skeletal muscles used to be strenuous and often impossible to perform manually. Accordingly, long-term dynamic musculoskeletal imaging has not been performed. The feasibility of long-term dynamic musculoskeletal functional analysis using hands-free ultrasound will be demonstrated in ten healthy endurance runners. After every kilometer, the vastus lateralis muscle was imaged whilst running using a fixated probe connected to a smart phone. The image quality was quantified by estimation of the probe-skin contact preservation and the field-of-view stability. Moreover, the pennation angles and muscle thicknesses were computed automatically. Long-term dynamic acquisition was successful in nine out of ten runners. Probe-skin contact loss ranged between 0 and 57% of the gait cycle. The biggest change in field-of-view occurred during the first kilometer with an average decline in complex-wavelet structural similarity index of 0.21, followed by an onward total decrease of 0.09, on average. The mean pennation angle and thickness were approximately constant, with the average fluctuation being 0.94 degrees and 0.11 cm, respectively. The feasibility of long-term musculoskeletal function analysis has been demonstrated, with probe-skin contact loss the main limiting factor. Dynamic, hands-free ultrasound might enable research for a more profound insight in the prevention and rehabilitation of musculoskeletal injuries.

Objective: We recently demonstrated that an innovative asthma score independent of auscultation could accurately predict the requirement for bronchodilator nebulization compared to the physician's routine clinical judgment to administer bronchodilators. We aimed to standardize inpatient care for children with acute asthma by implementing a clinical pathway based on this innovative asthma score. Methods: We designed a nurse-driven clinical pathway. This pathway included standardized respiratory assessments and a protocol for the nursing staff to administer bronchodilators without a specific order from the physician. We compared the length of stay and the number of readmissions to a historical cohort. Results: Seventy-nine patients with moderate acute asthma completed the pathway. We obtained a total of 858 Childhood asthma scores in these patients, with a median of 11 scores per patient (interquartile range 8-17). Patients treated according to the nurse-driven protocol were 3.3 times more likely to be discharged earlier (hazard ratio, 3.29; 95% confidence interval, 2.33-4.66; P < 0.05), and length of stay was significantly reduced (median 28 versus 53 h) compared to the historical standard practice. On request, the attending physician assessed the patient's respiratory status 42 times (4.9% of all childhood asthma score assessments). Patient safety was not compromised, and none of the patients were removed from the pathway. In each group, we readmitted two (2.5%) patients within 1 week after discharge. Conclusion: This nurse-driven clinical pathway for children with acute asthma based on an asthma score independent of auscultation findings significantly decreased length of stay without compromising patient safety.

Additional file1. Peptide density fine tuning for uptake of CD38pep targeted nanoparticles.

Purpose: In dynamic musculoskeletal sonography, probe fixation can contribute to field of view (FOV) consistency, which is necessary for valid analysis of architectural parameters. In this volunteer study, the achieved FOV consistency in fixated ultrasonography was quantified and compared with freehand acquisition. Methods: During five resting periods during cycling exercise, longitudinal B-mode images of the vastus lateralis (VL) muscle were acquired on one thigh with a fixated probe, and by two trained observers on the other thigh. In each acquisition, the structural similarity compared to the first resting period was determined using the complex wavelet structural similarity index (CW-SSIM). Also, the pennation angle of the VL was measured. Both CW-SSIM and pennation angle were compared between fixated and freehand acquisition. Furthermore, the compression of tissue by the probe fixation was measured. Results: In fixated acquisition, a significantly higher structural similarity (p < 0.05) and an improved repeatability of pennation angle measurement were obtained compared to freehand acquisition. Probe fixation compressed muscle tissue by 12% on average. Conclusions: Quantification of the structural similarity showed an increase in FOV consistency with sonography compared to freehand acquisition. The demonstrated feasibility of long-term fixated acquisition might be attractive in many medical fields and sports, and for reduction of work-related ergonomic problems among sonographers.

Objective: We recently demonstrated that an innovative asthma score independent of auscultation could accurately predict the requirement for bronchodilator nebulization compared to the physician’s routine clinical judgment to administer bronchodilators. We aimed to standardize inpatient care for children with acute asthma by implementing a clinical pathway based on this innovative asthma score. Methods: We designed a nurse-driven clinical pathway. This pathway included standardized respiratory assessments and a protocol for the nursing staff to administer bronchodilators without a specific order from the physician. We compared the length of stay and the number of readmissions to a historical cohort. Results: Seventy-nine patients with moderate acute asthma completed the pathway. We obtained a total of 858 Childhood asthma scores in these patients, with a median of 11 scores per patient (interquartile range 8–17). Patients treated according to the nurse-driven protocol were 3.3 times more likely to be discharged earlier (hazard ratio, 3.29; 95% confidence interval, 2.33–4.66; P < 0.05), and length of stay was significantly reduced (median 28 versus 53 h) compared to the historical standard practice. On request, the attending physician assessed the patient’s respiratory status 42 times (4.9% of all childhood asthma score assessments). Patient safety was not compromised, and none of the patients were removed from the pathway. In each group, we readmitted two (2.5%) patients within 1 week after discharge. Conclusion: This nurse-driven clinical pathway for children with acute asthma based on an asthma score independent of auscultation findings significantly decreased length of stay without compromising patient safety.

In the Netherlands, youth-healthcare (YHC) physicians screen children 7 times for vision disorders between the ages of 1 and 60 months. Examination consists of inspection of the external structures of the eye, fundus red reflex, Hirschberg test, pupillary reflexes, cover-uncover test, alternating-cover test, eye motility, monocular pursuit, and, from 36 months onwards, visual acuity (VA). We observed how well these tests are done.Screening test performance was assessed with semistructured observations. Two orthoptic students developed a semistructured observation form. In addition to extensive instructions from an orthoptist and YHC-physicians instructor, they attended 2 one-day courses for YHC physicians. Tests were assessed using criteria based on the Dutch Child Vision Screening Guideline version 2010 and the Dutch Manual for Orthoptic Examination. Type of chart, testing distance, and starting eye were recorded for VA measurements. The observations in the first week were done simultaneously by the two observers and checked for concordance.Concordance between the two observers was good. Twenty-five YHC physicians were observed during 100 days in total. Two physicians were excluded because they examined few children. The remaining 23 physicians examined 329 children, of whom 82 were aged 1-4 months, 157 aged 6-24 months, and 90 aged 36-45 months of age. Fundus red reflex was performed in 89% of children, Hirschberg test in 88%, pupillary reflexes in 14%, cover-uncover test in 65%, alternating-cover test in 62%, eye motility in 68%, monocular pursuit in 23%, and VA at 36-45 months in 94%. Forty-eight percent of cover-uncover tests, 36% of alternating-cover tests, and 7% of eye motility tests were performed correctly. VA was measured at 3 meters in 2%, others at 5 meters in accordance with the guideline. A picture chart was used instead of the Landolt-C at the age of 45 months in 23%. VA measurements were performed correctly in 89%, fundus red reflex in 89%, and Hirschberg test in 87%.Hirschberg test, fundus red reflex, and VA were adequately tested in most cases. Cover-uncover test, alternating-cover test, and eye motility were often performed inadequately. Pupillary reflexes were skipped often as room lights could not be dimmed.

As our ability to synthesize and modify nanoobjects has improved, efforts to explore nanotechnology for diagnostic purposes have gained momentum. The variety of nanoobjects, especially those with polyvalent properties, displays a wide range of practical and unique properties well suited for applications in various diagnostics. This review briefly covers the broad scope of multivalent nanoobjects and their use in diagnostics, ranging from ex vivo assays and biosensors to in vivo imaging. The nanoobjects discussed here include silica nanoparticles, gold nanoparticles, quantum dots, carbon dots, fullerenes, polymers, dendrimers, liposomes, nanowires, and nanotubes. In this review, we describe recent reports of novel applications of these various nanoobjects, particularly as polyvalent entities designed for diagnostics.

Zoals elk jaar werd er ook dit jaar een Diesweek georganiseerd. Deze keer met het thema 'Grootmachten'. Hieronder vindt u een overzicht van deze zeer geslaagde week.

Wouter Welling is coördinerend beleidsmedewerker digitale overheid bij het ministerie van Binnenlandse Zaken en Koninkrijksrelaties. Na een post-master politieke geschiedenis en een traineeship informatiemanagement bij PBLQ is hij bij Logius terechtgekomen. Dit is een onderdeel van de Rijksoverheid datzich bezighoudt met de overheid en ICT. "Wat betekent de digitalisering van de maatschappij voor Nederland? Op dit moment merk je dat het pas op de maatschappelijke agenda komt als er iets misgaat, zoals de parlementaire enquête over de ICT projecten bij de ■ • • ■ overheid. Maar eigenlijk verdient dit onderwerp meer aandacht. Wat gebeurt er bijvoorbeeld met kwetsbare groepen die de digitalisering niet bij kunnen houden, als de overheid alles digitaal gaat doen? Tegelijkertijd biedt de digitale overheid juist meer kansen voor de zelfredzame types van onze generatie:'

Nog niet zo lang geleden liep Amber Brantsen door de gangen van de Universiteit Leiden. Nu loopt ze door de gangen van het NOS-gebouw in Hilversum en groet ze haar journalistieke collegàs hartelijk. Hoe kijkt de presentatrice terug op haar tijd als Bestuurskunde studente?

Het eerste half jaar heeft de Alumnicommissie 'Alumissie' van de B.I.L. al hard gewerkt. Zo zijn wij aanwezig geweest bij de prinsjesdaganalyse, een interessante alumnilezing aan het voorbereiden en voor u ligt de eerste editie van de Bestuurskundige Berichten. Hieronder stelt de Alumnicommissie zich voor. Wij hopen u allen te mogen verwelkomen op de activiteiten en wensen u voor nu veel leesplezier toe!

De B.I.L. heeft de afgelopen maanden genoeg activiteiten georganiseerd en absoluut niet stilgezeten. Zo werden de bestemmingen van de reizen bekend en werden de eerste feesten gegeven. Een kort overzicht.

Begin december sprak de redactie met de kersverse staatssecretaris van Sociale Zaken en Werkgelegenheid. Tamara van Ark ( 43) studeerde Bestuurskunde aan de universiteit van Rotterdam. Na haar studie was zij onder andere werkzaam bij verschillende consultancybedrijven en de sociale dienst van de gemeente Rotterdam. Daarna is mevrouw van Ark wethouder geweest bij de gemeente Zuidplas en tijdens de kabinetten Rutte I en Rutte II zat zij in de Tweede Kamer voor de VVD, in Rutte I als woordvoerder Zorg en in Rutte II als vicefractievoorzitter.

Organizations can no longer rely solely on their own resources to innovate and look for strategic interactions beyond their organizational boundaries, allowing them to improve the quality of their own internal resources by investing in core competencies while contracting out other knowledge domains. From a theoretical perspective the focus of research has shifted towards supplier relationship management (SRM) and early supplier involvement in new product development (NPD). Even though much research has been done in these areas, a more comprehensive study investigating the constructs that determine the quality of a relationship still has to be done. Furthermore, the existing research has largely focused either on the role of SRM with regard to NPD performance or on knowledge transfer and its impact on NPD performance. Research encompassing these two important aspects of the NPD process is still lacking. Thirdly, our study expands the field of research beyond the automotive industry, by focusing on consumer product industry. Lastly, how SRM affects knowledge transfer and in turn NPD performance has yet not been researched. Our findings confirm the positive relationship between relationship quality, knowledge transfer and NPD performance. Managing supplier relationships leads to a higher quality relationship which contributes to the performance of NPD projects. Secondly, a total of thirteen constructs have been identified to be decisive for the quality of a relationship. These constructs act on either an individual or organizational level. Our study underlines the importance of supplier relationship management in a NPD context and the developed research model can be used to predict the performance of a NPD project by measuring the quality of the relationship between buyer and supplier on these thirteen constructs.

BACKGROUND: Studies suggest an effect of nebulized hypertonic saline solution on air-flow limitation in subjects with respiratory syncytial virus (RSV) bronchiolitis, but results are based on subjective scores of clinical severity and are not clear. In this observational study, we used a noninvasive computerized tool to quantify wheezing before and after nebulization with hypertonic saline in children admitted for RSV infection.METHODS: Twenty-seven children (≤ 24 months old) admitted to the pediatric ward of the Medical Center Leeuwarden with polymerase chain reaction-confirmed RSV bronchiolitis were included. Subjects were simultaneously assessed both clinically and by computerized acoustic monitoring before and 15 min after treatment with nebulized hypertonic saline solution.RESULTS: Clinical assessment, defined by the Respiratory Distress Assessment Instrument score, did not change after nebulization (n = 27, 5.0 vs 4.7, P = .17). Computerized acoustic monitoring showed no improvement in wheezing (n = 27, 3.4% vs 2.0%, P = .05) or inspiration/expiration ratio (0.85 vs 0.85, P = .93) after nebulization.CONCLUSIONS: Hypertonic saline nebulization does not improve air flow, as assessed by both clinical and computerized acoustic scores, in children admitted for RSV.