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Study question Does offering the ‘Pleasure&Pregnancy programme’ rather than expectant management affect sexual desire, pleasure and satisfaction, intercourse frequency and ongoing pregnancy rates in subfertile couples? Summary answer The ‘Pleasure&Pregnancy programme’ limits the decline in sexual desire and intercourse frequency but does not affect sexual pleasure and satisfaction and ongoing pregnancy rates. What is known already Dutch guidelines advise six months of non-interactive expectant management, in couples with unexplained subfertility and Hunault-prognosis of minimally 30%, rather than immediately starting assisted reproduction. Adherence to this advice is limited as both couples and fertility clinic staff feel an urge for action. Underpowered studies indicated that face-to-face sex-counselling may increase the pregnancy rates of these couples. Interactive eHealth programmes proved as effective as face-to-face sex counselling in other patient populations. Our group developed the interactive six months Pleasure&Pregnancy web-based programme, aiming to help couples maintain or improve sexual pleasure and activity and consequently increase chances on naturally conceived pregnancies. Study design, size, duration This multi-centre trial randomised 701 couples between six months of the Pleasure&Pregnancy programme (n = 349) or expectant management, the current standard of care (n = 353) from 2016 to 2021. The Pleasure&Pregnancy web-based programme contains eight modules combining psychosexual education with couple communication, mindfulness and sensate focus exercises and additionally enables couples to interact with professionals and peers. Sexual outcomes were assessed with a diary and reliable questionnaires at baseline, three and six months. Participants/materials, setting, methods Heterosexual couples with unexplained subfertility and a Hunault-prognosis of minimally 30% were included after their diagnostic work-up in 41 Dutch fertility clinics. All analyses were according to intention-to-treat principles. Differences between groups in ongoing pregnancy rates (naturally conceived within six months after randomization; primary outcome) were expressed as relative risks (RR). Linear mixed models assessed time, group and interactive effects on female/male sexual desire, pleasure and satisfaction, and intercourse frequency; mean differences (MD) are provided. Main results and the role of chance Response rates at baseline, three and six months for the diaries assessing sexual pleasure (Quality of Sexual Experience; QSE) were, respectively: 55.8%, 33.9% and 16.8%. For the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) questionnaires assessing intercourse frequency, sexual desire and satisfaction response rates were, respectively: 83.2%, 50.8% and 41.2%. The probability of a naturally conceived ongoing pregnancy within six months after randomization did not differ between the randomized groups, and was 22% (n = 78/349) in the Pleasure&Pregnancy-group and 24% (n = 83/353) in the control group (RR 0.94; 95% CI 0.67 to 1.32). Neither did the groups differ in time to pregnancy (log rank p = 0.46). Both female and male sexual pleasure and satisfaction was comparable in both groups and did not change over time. Male sexual desire (scale 2-10) remained over time in the Pleasure&Pregnancy-group but decreased in the control group (MD 0.47, 95%CI 0.28 to 0.67, p Limitations, reasons for caution The intended sample size of 1164 was not reached, although the inclusion period was doubled. Web-based tracking showed limited intervention adherence, indicating the need for per protocol analysis in addition to this intention-to-treat analysis. Examining user experiences with the Pleasure&Pregnancy programme would be of interest and might explain adherence rate. Wider implications of the findings Clinics are advised to offer the Pleasure&Pregnancy or similar programme to care for the sexual health of couples with unexplained subfertility. The Pleasure&Pregnancy programme did not increase naturally conceived ongoing pregnancy rates but did help couples maintain their sexual desire and intercourse frequency, while continuing to attempt natural conception. Trial registration number NTR5709

Brody disease is a rare inherited myopathy due to reduced sarcoplasmic reticulum Ca(2+) ATPase (SERCA)1 activity caused by mutations in ATP2A1, which causes delayed muscle relaxation and silent cramps. So far the disease has mostly been diagnosed by measurement of SERCA1 activity. Since mutation analysis became more widely available, it has appeared that not all patients with reduced SERCA1 activity indeed have ATP2A1 mutations, and a distinction between Brody disease (with ATP2A1 mutations) and Brody syndrome (without ATP2A1 mutations) was proposed. We aim to compare the clinical features of patients with Brody disease and those with Brody syndrome and detect clinical features which help to distinguish between the two. In addition, we describe the Brody syndrome phenotype in more detail. We therefore performed a literature review on clinical features of both Brody disease and Brody syndrome and a cross-sectional clinical study consisting of questionnaires, physical examination, and a review of medical files in 17 Brody syndrome patients in our centre. The results showed that Brody disease presents with an onset in the 1st decade, a generalized pattern of muscle stiffness, delayed muscle relaxation after repetitive contraction on physical examination, and autosomal recessive inheritance. Patients with Brody syndrome more often report myalgia and experience a considerable impact on daily life. Future research should focus on the possible mechanisms of reduction of SERCA activity in Brody syndrome and other genetic causes, and on evaluation of treatment options.

A high-precision and low-power miniaturized digital sun sensor has been developed at TNO. The single-chip sun sensor comprises an application specific integrated circuit (ASIC) on which an active pixel sensor (APS), read-out and processing circuitry as well as communication circuitry are combined. The design was optimized for low recurrent cost. The sensor is albedo insensitive and the prototype combines an accuracy in the order of 0.03o with a mass of just 72 g and a power consumption of only 65 mW.

Item does not contain fulltext Brody disease is a rare inherited myopathy due to reduced sarcoplasmic reticulum Ca(2+) ATPase (SERCA)1 activity caused by mutations in ATP2A1, which causes delayed muscle relaxation and silent cramps. So far the disease has mostly been diagnosed by measurement of SERCA1 activity. Since mutation analysis became more widely available, it has appeared that not all patients with reduced SERCA1 activity indeed have ATP2A1 mutations, and a distinction between Brody disease (with ATP2A1 mutations) and Brody syndrome (without ATP2A1 mutations) was proposed. We aim to compare the clinical features of patients with Brody disease and those with Brody syndrome and detect clinical features which help to distinguish between the two. In addition, we describe the Brody syndrome phenotype in more detail. We therefore performed a literature review on clinical features of both Brody disease and Brody syndrome and a cross-sectional clinical study consisting of questionnaires, physical examination, and a review of medical files in 17 Brody syndrome patients in our centre. The results showed that Brody disease presents with an onset in the 1st decade, a generalized pattern of muscle stiffness, delayed muscle relaxation after repetitive contraction on physical examination, and autosomal recessive inheritance. Patients with Brody syndrome more often report myalgia and experience a considerable impact on daily life. Future research should focus on the possible mechanisms of reduction of SERCA activity in Brody syndrome and other genetic causes, and on evaluation of treatment options.

The paper presents the latest results in the design of FAST-D, the Dutch micro-satellite for the Dutch–Chinese FAST (Formation for Atmospheric Science and Technology demonstration) formation flying mission. Over the course of the 2.5 year mission, the two satellites, FAST-D and FAST-T, will demonstrate various new technologies and perform observations of atmospheric aerosols and seasonal variations of height profiles in the cryosphere using spectropolarimeter and altimeter payloads on both spacecraft. A conceptual design for the Dutch spacecraft, FAST-D, is presented. Special focus is laid on the design of the attitude determination and control subsystem and on the space-based computing experiments to be performed on this spacecraft. Furthermore, new results in the development of the science payloads on FAST-D, the aerosol characterisation instrument SPEX (Spectropolarimeter for Planetary Exploration) and the altimeter SILAT (Stereo Imaging Laser Altimeter), are described. For SPEX, several design changes have been made to make the instrument more compatible with the FAST mission. For SILAT, an instrument re-design for Earth missions is presented, which results in considerable mass savings as compared to the earlier design.

The chapter treats the mission design for the Dutch-Chinese FAST (Formation for Atmospheric Science and Technology demonstration) mission. The space segment of the 2.5 year mission consists out of two formation flying micro-satellites. During the mission, new technologies will be demonstrated and, using spectropolarimeter and altimeter payloads on both spacecraft, observations will be performed characterizing atmospheric aerosols and seasonal variations of height profiles in the cryosphere. The mission is divided into four phases, each with a different orbital geometry. The rationale for and the orbital geometry during these phases as well as the transitions between the phases are treated in detail. A major complication to the mission design is the amount of data that can be sent to the ground. Since only two moderately capable ground stations, one in Delft and one in Beijing, are baselined, as much data processing as possible has to be performed onboard to allow high duty factors for the science payloads. When this is not possible, alternative payload operation modes have to be sought with which maximum scientific data return can be obtained through as little payload operation as possible. Both options are dealt with in the chapter.

Vaginal surgery may affect sexual function both positively and negatively. Possibly, negative consequences of surgical interventions on sexuality may be caused by reduced sensibility of the vaginal wall.To develop a new method to measure vaginal sensibility.We developed a technique to measure the sensibility of the vaginal wall consisting of a St Marks electrode on a gloved index finger, with a stimulating electrode mounted at the tip. Measurements were performed in four different target areas (caudal and cranial, posterior and anterior) by two independent female researchers in a random order. Subjects were 12 healthy women.The intra-observer reproducibility of both researchers was almost perfect (Pearsons-Rho correlation coefficient 0.77-0.960.001). The inter-observer reproducibility was moderate (Pearsons-Rho correlation coefficient 0.39-0.49). Both researchers measured increased sensibility in the cranial posterior vaginal wall relative to the cranial anterior vaginal wall, but for all measurements, researcher 2 obtained higher sensibility ratings than researcher 1. In addition, researcher 2 found a decreased sensibility in the cranial anterior vaginal wall for women not using oral contraceptives. Phase of the menstrual cycle did not influence vaginal sensibility.We developed a new instrument to measure vaginal sensibility. The instrument has excellent intra-observer reproducibility. This method is sufficiently sensitive so as to differentiate between anterior and posterior cranial vaginal wall sensibility, but outcome differs as a function of researcher. Further evaluation of the clinical use of this method is needed, provided that measurements are performed by the same researcher.

This paper reviews reliability, specificity, and practical applicability of the two most promising and widely used methods for measuring blood flow within the vagina: the oxygenation-temperature method and vaginal photoplethysmography. It was concluded that the oxygenation-temperature method and vaginal pulse amplitude as measured by the photoplethysmograph are both specific indicators of physiological sexual arousal. Although vaginal pulse amplitude seems to be the method of choice for measuring vaginal vasocongestion up to orgasm, and the oxygenation-temperature method for measuring orgasm, these measures should not be used in isolation. It is argued that women's sexual function should be evaluated using vaginal vasocongestion measures in conjunction with subjective indices. Finally, the field is in need of studies comparing physiological and subjective sexual responses in clinical and non-clinical groups.

Introduction: infants with aortic coarctation may have altered cerebral perfusion. With Near-infrared Spectroscopy (NIRS), cerebral tissue oxygen extraction (FTOE) is calculated. FTOE reflects cerebral perfusion. Objective: To determine the course of FTOE in the first 48 hours (hrs) of admission in infants with aortic coarctation and to relate this course to short-term outcome. Methods: We included all infants with aortic coarctation and circulatory failure admitted to the NICU of the UMCG in 2009-2010 in whom NIRS-monitoring was performed. Mean values of FTOE were calculated every 12hrs over 2hr-periods. Adverse outcome was defined as need for emergency surgery or death. Results: We included seven infants. Median gestational age was 37.3 weeks (range:31.7-39.6), birth weight: 3340 grams (1345-3910), postnatal age: 10 days (1-18), lactate at admission: 6.7 mmol/l (2.5-19.8). Two infants had an adverse outcome within 36hrs after admission; one needed emergency surgery, one died. infants with adverse outcome showed a high and continuously increasing FTOE over 36hrs while infants with favourable outcome showed a lower and stabilizing FTOE (Table). Conclusion: infants with aortic coarctation show a high FTOE during the first 48hrs of admission, which indicates compromised cerebral perfusion possibly due to circulatory failure. Increasing FTOE over the first 36hrs of admission might indicate adverse short-term outcome. [Course of FTOE in infants with aortic coarctation]