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Background: Despite systemic anticoagulation and antithrombotic surface coating, oxygenator dysfunction remains one of most common technical complications of Extracorporeal membrane oxygenation (ECMO). Several parameters have been associated with an oxygenator exchange, but no guidelines for when to perform an exchange are published. An exchange, especially an emergency exchange, has a risk of complications. Therefore, a delicate balance between oxygenator dysfunction and the exchange of the oxygenator exists. This study aimed to identify risk factors and predictors for elective and emergency oxygenator exchanges. Methods: This observational cohort study included all adult patients supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO). We compared patients' characteristics and laboratory values of patients with and without an oxygenator exchange and between an elective and emergency exchange, defined as an exchange outside office hours. Risk factors for an oxygenator exchange were identified with cox regression analyses, and risk factors for an emergency exchange were identified with logistic regression analyses. Results: We included forty-five patients in the analyses. There were twenty-nine oxygenator exchanges in nineteen patients (42%). More than a third of the exchanges were emergency exchanges. Higher partial pressure of carbon dioxide (PaCO2), transmembrane pressure difference (ΔP), and hemoglobin (Hb) were associated with an oxygenator exchange. Lower lactate dehydrogenase (LDH) was the only risk factor for an emergency exchange. Conclusion: Oxygenator exchange is frequent during V-V ECMO support. PaCO2, ΔP and Hb were associated with an oxygenator exchange and lower LDH with the risk of an emergency exchange. [ABSTRACT FROM AUTHOR]

Exploring the impact of contractures in adolescents and young adults (AYA) with spinal muscular atrophy (SMA) on daily functioning and participation and the impact of received contracture management. We included 14, non-ambulant AYA with SMA types 2/3 (10 females and 4 males), aged 16–30 years. Interviews focused on two topics: perceived impact of contractures on daily functioning and of previous contracture management. We used inductive thematic analysis for interview analysis. In general, participants experienced muscle weakness to be more of a hindrance than contractures; they had adapted to their contractures over time. Participants considered contracture treatment useful when goals were meaningful and realistic. Participants mentioned that their perspective on contracture management would change in light of a promise of improved motor function due to disease-modifying treatment. Despite the relatively low impact of contractures in comparison to the loss of muscle strength, non-ambulant AYA with SMA should be informed on the potential impact of contractures and benefits and potential adverse effects of their management. This information can support the shared decision-making process. While respecting individual choices, allows for incorporating interventions into daily life and the promotion of daily functioning and participation when children with SMA are growing up. The variability of the perceived impact of contractures in non-ambulant adolescents and young adults with spinal muscular atrophy (SMA) underscores the need for individualized assessment and contracture management based on discussions about challenges, benefits and burden. In the treatment plan for contracture management in SMA it is important to take into account: 1) that adolescents often experienced physiotherapy as additional comfort, with less feeling of stiffness, and 2) that most perceived orthosis and standers as unnecessary and burdensome as contracture management. Clinicians should consider postural management in an early stage given the improved prognosis on motor development of children with SMA. Clinicians should monitor and revisit treatment goals, benefits and adverse effects on a regular basis as part of the shared goal-setting and decision-making in contracture management for children with SMA. [ABSTRACT FROM AUTHOR]

Aims: Parents of children with spinal muscular atrophy (SMA) often struggle with the all‐consuming nature of the demands of caring for a child with substantial physical needs. Our aim was to explore experiences, challenges and needs of parents of a child with SMA in a COVID‐19 pandemic situation. Method: Nineteen parents of 21 children (15 months to 13 years of age) with SMA types 1–3 participated in semi‐structured interviews in June to July 2020. The interviews were analysed using inductive thematic analysis. Results: Parents mentioned the protection of the health and well‐being of the child as the central perspective and driving force during the COVID‐19 pandemic. Three subthemes were identified: (1) responsibility, (2) balancing vulnerability and resilience and (3) (in)security. Some parents focused on the positive aspects during the lockdown, such as continuation of nusinersen treatment and family life. Some parents described helpful and positive cognitions to cope with the situation. In general, parents described a need for information with regard to COVID‐19 and their child with SMA and a need for discussing their dilemmas and insecurities with a healthcare professional. Interpretation: Parents put the health and well‐being of their children first during the pandemic. From this study, we learned that parents of children with SMA need information and value direct contact with a healthcare professional to share their dilemmas and insecurities. The dialogue can help to empower parents in the conflicts and decisions they have to make during a pandemic. [ABSTRACT FROM AUTHOR]

Background: Although life-saving in selected patients, ECMO treatment still has high mortality which for a large part is due to treatment-related complications. A feared complication is ischemic stroke for which heparin is routinely administered for which the dosage is usually guided by activated partial thromboplastin time (aPTT). However, there is no relation between aPTT and the rare occurrence of ischemic stroke (1.2%), but there is a relation with the much more frequent occurrence of bleeding complications (55%) and blood transfusion. Both are strongly related to outcome. Methods: We will conduct a three-arm non-inferiority randomized controlled trial, in adult patients treated with ECMO. Participants will be randomized between heparin administration with a target of 2–2.5 times baseline aPTT, 1.5–2 times baseline aPTT, or low molecular weight heparin guided by weight and renal function. Apart from anticoagulation targets, treatment will be according to standard care. The primary outcome parameter is a combined endpoint consisting of major bleeding including hemorrhagic stroke, severe thromboembolic complications including ischemic stroke, and mortality at 6 months. Discussion: We hypothesize that with lower anticoagulation targets or anticoagulation with LMWH during ECMO therapy, patients will have fewer hemorrhagic complications without an increase in thromboembolic complication or a negative effect on their outcome. If our hypothesis is confirmed, this study could lead to a change in anticoagulation protocols and a better outcome for patients treated with ECMO. Trial registration: ClinicalTrials.gov NCT04536272. Registered on 2 September 2020. Netherlands Trial Register NL7969 [ABSTRACT FROM AUTHOR]

The economic, environmental and social sustainability of Dutch dairy farms have attracted increasing societal concern in the past decades. In this paper, we propose a recently developed dynamic Luenberger indicator based on the by-production model to measure dynamic productivity growth in the economic, environmental and social dimensions of sustainability of Dutch dairy farms. Subsequently, we investigate the statistical associations between productivity growth and socio-economic factors using the OLS bootstrap regression model. We find that dairy farms have suffered a decline in dynamic sustainable productivity growth, especially in the environmental dimension where it is more pronounced than in the economic and social dimensions. Furthermore, we find that both technical and scale inefficiency change contribute to the decline of environmental productivity growth. Specialization and government support are associated with a higher economic and environmental sustainability productivity growth, and with, a decreased growth of social sustainable productivity. We found no significant association between the age of the oldest entrepreneur, financial structure, farm size or cost of advisory service and dynamic productivity growth in the three sustainability dimensions. The results provide insights into potential pathways towards improving the three pillars of sustainability. [ABSTRACT FROM AUTHOR]

We apply dynamic data envelopment analysis (DEA) to estimate dynamic cost inefficiency for a sample of European Union (EU) large meat processing firms over the period 2005–2012 and decompose this into the contributions of technical and allocative inefficiency. The estimation of dynamic inefficiencies controls for adjustment costs associated with firms' investments. We further contribute by measuring dynamic cost inefficiencies and their components with regard to own region group (managerial inefficiencies) and the gap between the pooled frontier and the region‐specific frontier (programme inefficiencies). Results show that technical inefficiency tends to be the largest component of cost inefficiency when both conducting the analysis for the EU as a whole and estimating a region‐specific frontier. Results suggest significant differences in cost, technical, and allocative inefficiencies between meat processing firms in eastern, western and southern EU countries. We also find that the gaps between the pooled and region‐specific frontiers tend to be small to negligible, which suggests that the main source of pooled inefficiencies are shortcomings in managerial practices rather than differences in region‐specific conditions. [ABSTRACT FROM AUTHOR]

This article examines the presence of spatial spillovers in farms' dynamic technical inefficiency scores using Data Envelopment Analysis and a second‐stage spatial truncated bootstrap regression model. Dynamic inefficiency is measured in terms of variable input contraction and gross investment expansion, while the second‐stage model allows an individual's dynamic inefficiency to be influenced by both own and neighbours' characteristics. The empirical application focuses on the panel data of specialised Dutch dairy farms observed over the period 2009–2016 and for which exact geographical coordinates of latitude and longitude are available. The results confirm the existence of spatial spillovers in farmers' dynamic technical inefficiency levels. Although changes in neighbours' subsidies do not significantly influence an individual's inefficiency, an increase in neighbours' age reduces an individual's performance, while an increase in neighbours' levels of intensification improves an individual's dynamic efficiency. [ABSTRACT FROM AUTHOR]

The aim of the present study was to explore the relation between both farm performance and antimicrobial use (AMU) of broiler farms. Farm performance was expressed as technical efficiency, obtained by using a bootstrap data envelopment analysis. AMU was expressed as treatment incidence. Cluster analysis is used to obtain groups of farms with similar characteristics regarding technical farm performance and AMU. Results indicate that the farms within the different clusters combine different technical farm performance and different levels of AMU. Between the clusters, significant differences were found in technical farm performance, AMU, the resource intensity of the number of animals at set-up, the number of antimicrobial treatments, the number of antimicrobial treatments related to either gut health or combined problems, and the number of antimicrobial treatments with either yellow or orange active substances. Farmers who combine high levels of AMU with high technical farm performance are likely to overestimate the real economic value of AMU. Proper coordination between the farmer and the veterinarian can be crucial in that case for reducing AMU. Farms with low performance are likely to have poor farm conditions. Improving those farm conditions can help reducing the need for AMU on this kind of farms. The farm-specific conditions have to be considered in future policies aimed at reducing AMU in livestock production. [ABSTRACT FROM AUTHOR]

While phosphorus fertilizers contribute to food security, part of the introduced phosphorus dissipates into water bodies leading to eutrophication. At the same time, conventional mineral phosphorus sources are increasingly scarce. Therefore, closing phosphorus cycles reduces pollution while decreasing trade dependence and increasing food security. A major part of the phosphorus loss occurs during food processing. In this article, we combine a systematic literature review with investment and efficiency analysis to investigate the financial feasibility of recovering phosphorus from dairy processing wastewater. This wastewater is particularly rich in phosphorus, but while recovery technologies are readily available, they are rarely adopted. We calculate the Net Present Value (NPV) of investing in phosphorus recycling technology for a representative European dairy processing company producing 100,000 tonnes of milk per year. We develop sensitivity scenarios and adjust the parameters accordingly. Applying struvite precipitation, the NPV can be positive in two scenarios. First, if the phosphorus price is high (1.51 million EUR) or second if phosphorus recovery is a substitute for mandatory waste disposal (1.48 million EUR). However, for a variety of methodological specifications, the NPV is negative, mainly because of high input costs for chemicals and energy. These trade-offs between off-setting pollution and reducing energy consumption imply, that policy makers and investors should consider the energy source for phosphorus recovery carefully. • Phosphorus recovery from dairy processing waste water addresses pollution and supply scarcity simultaneously. • Economic assessment finds negative profitability (1.03 million EUR), driven by high energy input demand. • Profitability increases with increasing savings in disposal costs (1.48 million EUR) and increasing phosphorus prices (1.51 million EUR). • Trade-offs exist between pollution and energy consumption in phosphorus recovery, which needs to be considered in supporting policies. [ABSTRACT FROM AUTHOR]

Background: Step width is increased during dual-belt treadmill walking, in self-paced mode with virtual reality. Generally a familiarization period is thought to be necessary to normalize step width.Aim: The aim of this randomised study was to analyze the effects of two interventions on step width, to reduce the familiarization period.Methods: We used the GRAIL (Gait Real-time Analysis Interactive Lab), a dual-belt treadmill with virtual reality in the self-paced mode. Thirty healthy young adults were randomly allocated to three groups and asked to walk at their preferred speed for 5min. In the first session, the control-group received no intervention, the 'walk-on-the-line'-group was instructed to walk on a line, projected on the between-belt gap of the treadmill and the feedback-group received feedback about their current step width and were asked to reduce it. Interventions started after 1min and lasted 1min. During the second session, 7-10days later, no interventions were given.Findings: Linear mixed modeling showed that interventions did not have an effect on step width after the intervention period in session 1. Initial step width (second 30s) of session 1 was larger than initial step width of session 2. Step width normalized after 2min and variation in step width stabilized after 1min.Interpretation: Interventions do not reduce step width after intervention period. A 2-min familiarization period is sufficient to normalize and stabilize step width, in healthy young adults, regardless of interventions. A standardized intervention to normalize step width is not necessary. [ABSTRACT FROM AUTHOR]

Melatonin improves survival and functional impairment including hemolysis, thrombocytopenia, and hypotension when administered in a prophylactic manner or early after initiation of sepsis or endotoxemia. In the present study, melatonin was given not before first symptoms of systemic inflammation became manifest. Lipopolysaccharide was infused at a rate of 0.5 mg/kg × h to induce systemic inflammation in male Wistar rats. Melatonin (single dose 3 mg/kg × 15 min) was intravenously administered 180 and 270 min after starting of the lipopolysaccharide infusion. Systemic and vital parameters ( e.g., systemic blood pressure and breathing rate) as well as blood and plasma parameters (acid-base parameters; electrolytes; parameters of tissue injury such as glucose concentration, lactate concentration, hemolysis, and aminotransferase activities; parameters of thromboelastometry; and platelet count) were determined in regular intervals. Infusion of lipopolysaccharide led to characteristic symptoms of severe systemic inflammation including hypotension, metabolic acidosis and hypoglycemia, electrolyte and hemostatic disturbances, thrombocytopenia, and hemolysis. Melatonin neither decreased mortality nor reduced lipopolysaccharide-dependent changes to vital, blood, and plasma parameters. Even though melatonin may have a beneficial effect in early stages of systemic inflammation, it can hardly be an option in therapy of manifest sepsis or endotoxemia in an intensive care unit. [ABSTRACT FROM AUTHOR]

We propose a new method for measuring and decomposing input-specific productivity change in a dynamic context. The resulting input-specific dynamic Luenberger productivity change indicator is decomposed to identify the contributions of input-specific dynamic technical, technical inefficiency and scale inefficiency changes. The empirical application of the paper focuses on panel data of large firms in the European dairy processing industry over the period 2005-2012. The results show similar patterns for dynamic input-specific productivity change and its components for labour across European regions (Eastern, Western and Southern), while differences between regions are found regarding materials and investments. [ABSTRACT FROM AUTHOR]

This article analyzes the productivity growth of the Spanish dairy processing industry from 1996 till 2011, which concerns the period of increased EU regulation regarding food safety as well as economic crisis. Data envelopment analysis is used to compute the Malmquist index and its components. The results suggest that productivity on average declined during the period under investigation. The decomposition of the Malmquist index finds that technical regress contributed to productivity decline despite improvements in technical and scale efficiencies. Our results also suggest that food safety regulations did not have a negative impact on productivity growth. Technical change and scale efficiency change made significant negative contributions to productivity growth in the period under crisis, whereas firms significantly improved their technical efficiency in that period. [ABSTRACT FROM PUBLISHER]

The conventional model on the distribution of electrolyte infusions states that water will distribute proportionally over both the intracellular (ICV) and extracellular (ECV) volumes, while potassium homes to the ICV and sodium to the ECV. Therefore, total body potassium is the most accurate measure of ICV and thus potassium balances can be used to quantify changes in ICV. In cardiothoracic patients admitted to the ICU we performed complementary balance studies to measure changes in ICV and ECV. In 39 patients, fluid, sodium, potassium, and electrolyte-free water (EFW) balances were determined to detect changes in ICV and ECV. Cumulatively over 4 days, these patients received a mean ± SE infusion of 14.0 ± 0.6 L containing 1465 ± 79 mmol sodium, 196 ± 11 mmol potassium and 2.1 ± 0.1 L EFW. This resulted in strongly positive fluid (4.0 ± 0.6 L) and sodium (814 ± 75 mmol) balances but in negative potassium (-101 ± 14 mmol) and EFW (-1.1 ± 0.2 L) balances. We subsequently compared potassium balances (528 patients) and fluid balances (117 patients) between patients who were assigned to either a 4.0 or 4.5 mmol/L blood potassium target. Although fluid balances were similar in both groups, the additionally administered potassium (76 ± 23 mmol) in the higher target group was fully excreted by the kidneys (70 ± 23 mmol). These findings indicate that even in the context of rapid and profound volume expansion neither water nor potassium moves into the ICV. [ABSTRACT FROM AUTHOR]

This study compared the economic feasibility of production systems with different levels of animal welfare (AW) in the broiler, laying hen, and fattening pig sectors. Economic feasibility over a five-year time horizon was assessed using stochastic bio-economic simulation models. The results suggest that the main determinant of economic feasibility in each sector is the producer price. It is not only the level of the price premium but also the certainty and variability of this premium that is important in the decision to convert to an alternative system. From the perspective of the farm, different approaches should be followed in the three sectors to further develop the market for products with higher levels of AW. The results imply that the broiler sector has the best perspective in the short to medium term for developing this market. In the fattening pig sector, conversion options should be made more financially attractive, for example by increasing price premiums or providing conversion subsidies. The laying hen sector has the worst prospects for improving AW in the short to medium term. Therefore, given the current production systems in this sector, producer price premiums need to be increased in order to increase the adoption of alternative production systems. [ABSTRACT FROM AUTHOR]

This study used the Theory of Planned Behavior (TPB) to analyze the intention of Brazilian farmers to use improved natural grassland. The TPB hypothesizes that the adoption of an innovation is driven by the intention to use it, which in turn is determined by three socio-psychological constructs: attitude, subjective norm, and perceived behavioral control. These constructs are derived from beliefs. The theoretical framework and model were applied to a sample of 214 Brazilian cattle farmers. Based on the socio-psychological constructs that influence intention, two groups of farmers were identified; farmers that were willing and farmers that were unwilling to use improved natural grassland. Results showed that compared to unwilling farmers, willing farmers evaluated the use of improved natural grassland on their farms more favorably (attitude), they felt a greater social pressure upon them to adopt this innovation (social norm), and they reported a higher capability (perceived behavioral control) to use improved natural grassland. Willing and unwilling farmers also differed in their behavioral beliefs concerning the outcomes of using improved natural grassland, their normative beliefs concerning important others, and their control beliefs concerning factors that could facilitate or inhibit the use of improved natural grassland. The two groups did not differ in most of their socioeconomic characteristics, but did differ in their goals and relative risk attitudes. [ABSTRACT FROM AUTHOR]

Studies on the adoption of innovations usually ignore underlying psychological constructs that affect farmers’ decisions and behavior, such as intention, perceptions, and beliefs. This paper uses psychological constructs from the theory of planned behavior (TPB) to analyze factors that affect the adoption of improved natural grassland. The TPB hypothesizes that adoption is driven by intention, which in turn is determined by three psychological constructs: attitude, subjective norm, and perceived behavioral control. These three psychological constructs are derived from behavioral, normative and control beliefs, respectively. The first objective was to identify the influence of attitude, subjective norm, and perceived behavioral control on the intention of farmers to use improved natural grassland. The second objective was to understand the role of farmers’ beliefs as drivers of their attitude, subjective norm, and perceived behavioral control. The theoretical framework and model were applied to a sample of 214 Brazilian cattle farmers. Results showed that attitude, subjective norm, and perceived behavioral control were all positively and significantly correlated with intention. The intention of farmers to use improved natural grassland was therefore influenced by farmers’ evaluation of the use of improved natural grassland (attitude), their perceptions about the social pressure to use this innovation (subjective norm), and their perceptions about their own capability (perceived behavioral control). Six behavioral beliefs were the drivers of attitude: increase cattle weight gains, increase number of animals per hectare, have pasture throughout the year, increase pasture resistance, prevent soil erosion, and decrease feeding costs. Seven normative beliefs were the drivers of subjective norm: family, friends, neighbor farmers, cattle traders, workers in the place where they buy their inputs, extension agents, and government. Three control beliefs were the drivers of perceived behavioral control: sufficient knowledge, sufficient skills, and availability of qualified technical assistance. The drivers of attitude, subjective norm, and perceived behavioral control can be used by policy makers to increase the adoption rate of improved natural grassland. Emphasis should be given to the six perceived benefits of adopting improved natural grassland, the drivers of attitude. The individuals and groups who were found to influence farmers׳ decisions to use it, the drivers of subjective norm, can be used as channels to disseminate information about the innovation. The drivers of perceived behavioral control are factors which facilitate the use of improved natural grassland. Ensuring that these three factors are available to farmers can improve the adoption rate for this innovation. [ABSTRACT FROM AUTHOR]

This study used a stochastic bioeconomic simulation model to simulate the business and finan-cial risk of different broiler production systems over a 5-yr period. Simulation analysis was conducted using the @Risk add-in in MS Excel. To compare the impact of different production systems on economic feasibil-ity, 2 cases were considered. The first case focused on the economic feasibility of a completely new system, whereas the second examined economic feasibilities when a farm switches from a conventional to an ani-mal welfare-improving production system. A sensitiv-ity analysis was conducted to assess the key drivers of economic feasibility and to reveal systematic differences across production systems. The study shows that eco-nomic feasibility of systems with improved animal wel-fare predominantly depends on the price that farmers receive. Moreover, the study demonstrates the impor-tance of the level and variation of the price premium for improved welfare, particularly in the first 5 yr after conversion. The economic feasibility of the production system increases with the level of welfare improvements for a sufficiently high price level for broiler meat and low volatility in producer prices. If this is not the case, however, risk attitudes of farmers become important as well as the use of potential risk management instru-ments. [ABSTRACT FROM AUTHOR]

The objectives of dairy processing cooperatives differ from those of investor-owned firms (IOFs). However, the literature usually assumes the same performance measures for cooperatives vis-a-vis IOFs. This study compares the performance of dairy cooperatives and IOFs in major European dairy producing countries. A traditional input oriented approach is used and two alternative approaches are used to account for the differential objectives of cooperatives. Cooperatives' performance differs across the two approaches from being outperformed by IOFs using the input oriented approach to outperforming them when using an approach that is more in line with cooperatives' objectives. [ABSTRACT FROM AUTHOR]

This paper develops a dynamic model of investment under rational expectations, assuming farm-specific production technologies and adjustment cost structures. The model distinguishes regimes of negative, zero and positive investments and maintains that it is optimal for a farmer not to invest for a range of shadow prices, depending on thresholds for positive and negative investments. The model is applied to a rotating sample of Dutch pig farms over the period 1980-1996. Farm-specific parameters of the adjustment cost function and production technology are obtained using Generalised Maximum Entropy estimation. Cluster analysis using the farm-specific adjustment cost parameters indicates that five groups of farms with distinct adjustment cost structures can be identified. A tobit regression analysis is used to explain the impact of different socio-economic factors on the size of the threshold between positive and negative investments. [ABSTRACT FROM AUTHOR]

This paper analyses the factors underlying the probability that Dutch pig farmers have plans to (a) stop, (b) to increase farm size and/or (re)build a barn, (c) to improve the quality of the production process and (d) to make manure processing facility at the own farm. A computer-based questionnaire was carried out among pig farmers in 1999 and 2000. Farmer plans were analysed using a multivariate probit model. The results show that farm size and life cycle are important variables explaining the probability of farmers having plans. Furthermore, risk averse farmers more frequently have plans to improve the quality of the production process, whereas farmers with a negative attitude towards biological farming search for opportunities to make a manure processing facility at their own farm. Results also reveal that most plans are significantly correlated and that the explanatory power of the model is relatively low, with the latter finding suggesting that more study is required to obtain a good understanding of strategic planning. [Copyright &y& Elsevier]

This paper uses Data Envelopment Analysis to compute measures of the efficiency (relative to a frontier) in terms of the use of all inputs as well as for single inputs like CO2 and energy for a sample of greenhouse firms in the Netherlands over the period 1991–1995. These efficiency measures are generated for different firms specialised in production of vegetables, flowers, and potplants and with different heating technologies. The empirical results indicate that firms use energy quite efficiently and are less efficient in terms of CO2 emissions. Firms using conventional heating are overall less efficiently using energy and CO2 than firms using more advanced heating technologies. Most differences in efficiency between firm types and firms using different heating technologies are statistically significant. Scale adjustments can provide an important contribution to further efficiency improvements. [Copyright &y& Elsevier]

In response to societal concerns, the European Union set up goals to address the negative impact of intensive broiler production on animal welfare, the environment and human health. This paper aimed to 1) explore combinations of system changes that perform best in terms of farm income, animal welfare, emissions of ammonia (NH 3) and particulate matter (PM 10) and 2) are robust to changes in society's expectations relating to animal welfare and environmental sustainability. The prevailing system in the Dutch broiler market was used as a baseline for evaluating system changes. Animal welfare, NH 3 emissions and PM 10 emissions were the three external factors chosen for this evaluation. Farm income was quantified by the net return to labor and management (NRLM). Expert knowledge elicitation was used to identify system changes that were likely to be implemented in the baseline system. Combinations were made by selecting system changes from each of the chosen external factors. A deterministic model was used to calculate the effect of each combination of system changes on net return to labor and management. The performance of each combination was evaluated by estimating a benefit-of-the-doubt composite indicator. Results show that 8 out of 70 combinations indicated a better outcome and were more robust to potential changes in society's expectations relating to animal welfare and environmental sustainability. These combinations included two or more of the following system changes: 'lower density' (30 kg/m2), '2 types of enrichment', and 'daylight'. Furthermore, these combinations included 'tube heaters' for the abatement of NH 3 emissions, and 'negative air ionization system' or 'ionization filter' for the abatement of PM 10 emissions. To compensate for the decrease in NRLM associated with these practices and abatement techniques, a price premium was required that ranged between 4.8 and 18.5 eurocents/broiler. We conclude that combinations including animal welfare related system changes (lower density, enrichment and/or daylight), tube heaters and an ionization technique performed best and were robust to changes of societal expectations of these external factors. The insights obtained from this paper can support decision making in improving the sustainability of current broiler production systems. [Display omitted] • The European Union set up goals to improve the sustainability of broiler production. • This paper aimed to explore the performance of combinations of system changes in broiler production. • The performance of each combination was evaluated by developing a benefit-of-the-doubt composite indicator. • Combinations including an air ionization system for PM 10 reduction and tube heaters for NH 3 reduction performed best. • The insights can support decision making in improving the sustainability of current broiler production systems. [ABSTRACT FROM AUTHOR]

• A model for inefficiency evaluation including firms' CSR activities is proposed. • A model builds on the dynamic by-production model accounting for adjustment costs. • A model allows for non-convexities of the production set and input indivisibility. • An evidence for non-convexity and inputs' indivisibility is found. • A considerable inefficiency in socially responsible outputs is revealed. This article proposes a model for evaluating inefficiency accounting for firms' corporate social responsibility engagement as part of their broader output production activities. The model combines the production of marketable outputs, socially responsible outputs, and undesirable outputs into overall measures of firm performance using data envelopment approaches. Methodologically, the article builds on the dynamic by-production model, which accounts for adjustment costs related with investments, allowing for non-convexities of the production set and input indivisibility, as well as firm corporate social responsibility activities. This study compares dynamic technical inefficiency scores for each input, output, and investment, estimated assuming the presence of input indivisibility (non-convexity) and its absence (convexity). The empirical application focuses on European firms in three industries (offering capital, consumption, and other goods) for the period 2010–2017. The results show significant differences between inefficiencies with and without the convexity assumption and find evidence for non-convexity of firms' production set and inputs' indivisibility. Overall, among all outputs, the results reveal the highest inefficiency in the production of socially responsible outputs. [ABSTRACT FROM AUTHOR]

Business interaction is important for innovation performance but may be challenging in cross-border regions. The objective of this research was to investigate the relation between factors that define cross-border business interaction and innovativeness. From the cross-border regional innovation systems literature, we operationalized thirty-five factors which potentially influence cross-border business interaction; these factors concern availability of science and knowledge bases, socio-cultural proximity, accessibility, institutional set-up, and governance. We conducted a survey focusing on these factors and analyzed the data using Cronbach's alpha and linear regression. The cross-border interaction factors identified in the survey results served as independent variables and the differences in innovativeness levels in different European cross-border regions served as our dependent variable. This study confirmed that differences in innovativeness levels between countries can be related to factors hindering cross-border business interaction. [ABSTRACT FROM AUTHOR]

Background: Nonosmotic sodium storage has been reported in animals, healthy individuals and patients with hypertension, hyperaldosteronism and end-stage kidney disease. Sodium storage has not been studied in ICU patients, who frequently receive large amounts of sodium chloride-containing fluids. The objective of our study was to estimate sodium that cannot be accounted for by balance studies in critically ill patients. Chloride was also studied. We used multiple scenarios and assumptions for estimating sodium and chloride balances.Methods: We retrospectively analyzed patients admitted to the ICU after cardiothoracic surgery with complete fluid, sodium and chloride balance data for the first 4 days of ICU treatment. Balances were obtained from meticulously recorded data on intake and output. Missing extracellular osmotically active sodium (MES) was calculated by subtracting the expected change in plasma sodium from the observed change in plasma sodium derived from balance data. The same method was used to calculate missing chloride (MEC). To address considerable uncertainties on the estimated extracellular volume (ECV) and perspiration rate, various scenarios were used in which the size of the ECV and perspiration were varied.Results: A total of 38 patients with 152 consecutive ICU days were analyzed. In our default scenario, we could not account for 296 ± 35 mmol of MES in the first four ICU days. The range of observed MES in the five scenarios varied from 111 ± 27 to 566 ± 41 mmol (P < 0.001). A cumulative value of 243 ± 46 mmol was calculated for MEC in the default scenario. The range of cumulative MEC was between 62 ± 27 and 471 ± 56 mmol (P = 0.001 and P = 0.003). MES minus MEC varied from 1 ± 51 to 123 ± 33 mmol in the five scenarios.Conclusions: Our study suggests considerable disappearance of osmotically active sodium in critically ill patients and is the first to also suggest rather similar disappearance of chloride from the extracellular space. Various scenarios for insensible water loss and estimated size for the ECV resulted in considerable MES and MEC, although these estimates showed a large variation. The mechanisms and the tissue compartments responsible for this phenomenon require further investigation. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal life support (ECLS) is used to support the cardiorespiratory function in case of severe cardiac and/or respiratory failure in critically ill patients. According to the ELSO guidelines ECLS should be considered when estimated mortality risk approximates 80%. ECLS seems an efficient therapy in terms of survival benefit, but no undisputed evidence is delivered yet. The aim of the study is to assess the health-related quality of life after ECLS treatment and its cost effectiveness.Methods: We will perform a prospective observational cohort study. All adult patients who receive ECLS in the participating centers will be included. Exclusion criteria are patients in whom the ECLS is only used to bridge a procedure (like a high risk percutaneous coronary intervention or surgery) or the absence of informed consent. Data collection includes patient characteristics and data specific for ECLS treatment. Severity of illness and mortality risk is measured as precisely as possible using measurements for the appropriate age group and organ failure. For analyses on survival patients will act as their own control as we compare the actual survival with the estimated mortality on initiation of ECLS if conservative treatment would have been continued. Survivors are asked to complete validated questionnaires on health related quality of life (EQ5D-5 L) and on medical consumption and productivity losses (iMTA/iPCQ) at 6 and 12 months. Also the health related quality of life 1 month prior to ECLS initiation will be obtained by a questionnaire, if needed provided by relatives. With an estimated overall survival of 62% 210 patients need to be recruited to make a statement on cost effectiveness for all ECLS indications.Discussion: If our hypothesis that ECLS treatment is cost-effective is confirmed by this prospective study this could lead to an even broader use of ECLS treatment.Trial Registration: The trial is registered at ( NCT02837419 ) registration date July 19, 2016 and with the Dutch trial register, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6599. [ABSTRACT FROM AUTHOR]

Differences in technical efficiency across farms are one of the major factors explaining differences in farm survival and growth and changes in farm industry structure. This study employs Data Envelopment Analysis (DEA) to compute technical inefficiency scores for output, energy, materials, pesticides and fertiliser of a sample of Dutch indoor vegetable farms within the period 2006–2016. A bootstrap truncated regression model is used to determine statistical associations between producer-specific characteristics and technical inefficiency scores for the specified inputs. For the sample of indoor growers, the average technical inefficiency was about 14% for energy, 23% for materials, 24% for pesticides and 22% for fertilisers. The bootstrap truncated regression suggested that the degree of specialisation exerts adverse effects on the technical inefficiency of variable inputs. While age, short-term, long-term debt and subsidy were statistically significant, the coefficients were not economically significant. Building the capacity of farmers to reduce input inefficiency will enable farmers to be competitive and reduce the adverse effects of input overuse on the environment. [ABSTRACT FROM AUTHOR]

Traditional benchmarking implicitly assumes that decision making units operate in isolation from their peers. For arable production systems in particular, this assumption is unlikely to hold in reality. This paper quantifies spatial spillovers on input‐specific inefficiency using data envelopment analysis and a second‐stage bootstrap truncated regression model. The bootstrap algorithm is extended to allow for the estimation of the parameter of the spatial weight matrix, which captures the proximity between producers. The empirical application concerns Dutch arable farms for which latitudes and longitudes are available. The average inefficiency across years was 3.87% for productive inputs and 2.98% for damage abatement inputs under variable returns to scale. For productive inputs technical inefficiency, statistically significant spillover effects from neighbours' age and their degree of specialisation depended on the type of the spatial weight matrix used (inverse distance or k‐nearest neighbours). Statistically significant spillover effects of subsidy payments were adverse while statistically significant spillover effects from insurance payments were beneficial. For damage abatement inputs technical inefficiency, statistically significant adverse effects were found for neighbours' age and subsidy payments and beneficial effects from neighbours' insurance payments and their degree of specialisation. [ABSTRACT FROM AUTHOR]

The adoption rate of sensors on dairy farms varies widely. Whereas some sensors are hardly adopted, others are adopted by many farmers. A potential rational explanation for the difference in adoption may be the expected future technological progress in the sensor technology and expected future improved decision support possibilities. For some sensors not much progress can be expected because the technology has already made enormous progress in recent years, whereas for sensors that have only recently been introduced on the market, much progress can be expected. The adoption of sensors may thus be partly explained by uncertainty about the investment decision, in which uncertainty lays in the future performance of the sensors and uncertainty about whether improved informed decision support will become available. The overall aim was to offer a plausible example of why a sensor may not be adopted now. To explain this, the role of uncertainty about technological progress in the investment decision was illustrated for highly adopted sensors (automated estrus detection) and hardly adopted sensors (automated body condition score). This theoretical illustration uses the real options theory, which accounts for the role of uncertainty in the timing of investment decisions. A discrete event model, simulating a farm of 100 dairy cows, was developed to estimate the net present value (NPV) of investing now and investing in 5 yr in both sensor systems. The results show that investing now in automated estrus detection resulted in a higher NPV than investing 5 yr from now, whereas for the automated body condition score postponing the investment resulted in a higher NPV compared with investing now. These results are in line with the observation that farmers postpone investments in sensors. Also, the current high adoption of automated estrus detection sensors can be explained because the NPV of investing now is higher than the NPV of investing in 5 yr. The results confirm that uncertainty about future sensor performance and uncertainty about whether improved decision support will become available play a role in investment decisions. [ABSTRACT FROM AUTHOR]

Background: Evidence‐based recommendations for transfusion in patients with venoarterial extracorporeal membrane oxygenation (VA ECMO) are scarce. The current literature is limited to single‐center studies with small sample sizes, therefore complicating generalizability. This study aims to create an overview of red blood cell (RBC) transfusion in VA ECMO patients. Methods: This international mixed‐method study combined a survey with a retrospective observational study in 16 centers. The survey inventoried local transfusion guidelines. Additionally, retrospective data of all adult patients with a VA ECMO run >24 h (January 2018 until July 2019) was collected of patient, ECMO, outcome, and daily transfusion parameters. All patients that received VA ECMO for primary cardiac support were included, including surgical (i.e., post‐cardiotomy) and non‐surgical (i.e., myocardial infarction) indications. The primary outcome was the number of RBC transfusions per day and in total. Univariable logistic regressions and a generalized linear mixed model (GLMM) were performed to assess factors associated with RBC transfusion. Results: Out of 419 patients, 374 (89%) received one or more RBC transfusions. During a median ECMO run of 5 days (1st–3rd quartile 3–8), patients received a median total of eight RBC units (1st–3rd quartile 3–17). A lower hemoglobin (Hb) prior to ECMO, longer ECMO‐run duration, and hemorrhage were associated with RBC transfusion. After correcting for duration and hemorrhage using a GLMM, a different transfusion trend was found among the regimens. No unadjusted differences were found in overall survival between either transfusion status or the different regimens, which remained after adjustment for potential confounders. Conclusion: RBC transfusion in patients on VA ECMO is very common. The sum of RBC transfusions increases rapidly after ECMO initiation, and is dependent on the Hb threshold applied. This study supports the rationale for prospective studies focusing on indications and thresholds for RBC transfusion. [ABSTRACT FROM AUTHOR]

Classical swine fever ( CSF) is a highly contagious pig disease that causes economic losses and impaired animal welfare. Improving the surveillance system for CSF can help to ensure early detection of the virus, thereby providing a better initial situation for controlling the disease. Economic analysis is required to compare the benefits of improved surveillance with the costs of implementing a more intensive system. This study presents a comprehensive economic analysis of CSF surveillance in the Netherlands, taking into account the specialized structure of Dutch pig production, differences in virulence of CSF strains and a complete list of possible surveillance activities. The starting point of the analysis is the current Dutch surveillance system (i.e. the default surveillance-setup scenario), including the surveillance activities 'daily clinical observation by the farmer', 'veterinarian inspection after a call', 'routine veterinarian inspection', 'pathology in AHS', ' PCR on tonsil in AHS', ' PCR on grouped animals in CVI' and 'confirmatory PCR by NVWA'. Alternative surveillance-setup scenarios were proposed by adding 'routine serology in slaughterhouses', 'routine serology on sow farms' and ' PCR on rendered animals'. The costs and benefits for applying the alternative surveillance-setup scenarios were evaluated by comparing the annual mitigated economic losses because of intensified CSF surveillance with the annual additional surveillance costs. The results of the cost-effectiveness analysis show that the alternative surveillance-setup scenarios with ' PCR on rendered animals' are effective for the moderately virulent CSF strain, whereas the scenarios with 'routine serology in slaughterhouses' or 'routine serology on sow farms' are effective for the low virulent strain. Moreover, the current CSF surveillance system in the Netherlands is cost-effective for both moderately virulent and low virulent CSF strains. The results of the cost-benefit analysis for the moderately virulent CSF strain indicate that the current surveillance system in the Netherlands is adequate. From an economic perspective, there is little to be gained from intensifying surveillance. [ABSTRACT FROM AUTHOR]

The cross-border region of the Netherlands ( NL) and the two German states of North Rhine Westphalia ( NRW) and Lower Saxony ( LS) is a large and highly integrated livestock production area. This region increasingly develops towards a single epidemiological area in which disease introduction is a shared veterinary and, consequently, economic risk. The objectives of this study were to examine classical swine fever ( CSF) control strategies' veterinary and direct economic impacts for NL, NRW and LS given the current production structure and to analyse CSF's cross-border causes and impacts within the NL- NRW- LS region. The course of the epidemic was simulated by the use of InterSpread Plus, whereas economic analysis was restricted to calculating disease control costs and costs directly resulting from the control measures applied. Three veterinary control strategies were considered: a strategy based on the minimum EU requirements, a vaccination and a depopulation strategy based on NL and GER's contingency plans. Regardless of the veterinary control strategy, simulated outbreak sizes and durations for 2010 were much smaller than those simulated previously, using data from over 10 years ago. For example, worst-case outbreaks (50th percentile) in NL resulted in 30-40 infected farms and lasted for two to four and a half months; associated direct costs and direct consequential costs ranged from €24.7 to 28.6 million and €11.7 to 26.7 million, respectively. Both vaccination and depopulation strategies were efficient in controlling outbreaks, especially large outbreaks, whereas the EU minimum strategy was especially deficient in controlling worst-case outbreaks. Both vaccination and depopulation strategies resulted in low direct costs and direct consequential costs. The probability of cross-border disease spread was relatively low, and cross-border spread resulted in small, short outbreaks in neighbouring countries. Few opportunities for further cross-border harmonization and collaboration were identified, including the implementation of cross-border regions (free and diseased regions regardless of the border) in case of outbreaks within close proximity of the border, and more and quicker sharing of information across the border. It was expected, however, that collaboration to mitigate the market effects of an epidemic will create more opportunities to lower the impact of CSF outbreaks in a cross-border context. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the impact of investment in sensor systems on productivity change, using farm accounting data. Farm accounting data for the years 2008–2013 was available for 217 Dutch dairy farms. In addition, information was available on the adoption of sensor systems on these farms. For each farm, 5 input variables (number of dairy cows, number of hectares, total capital costs, total variable costs, and total labor costs) and 1 output variable (total revenues) were defined for each year. The Malmquist Total Factor Productivity index was used to examine productivity change for three categories of farms: farms without sensor systems, farms with sensor systems at an automatic milking system, and farms with sensor systems at a conventional milking system. The Malmquist index measures how the productivity of an individual farm changes over time and enables the contributions of technical change and technical efficiency change to be identified. Productivity did not change after investment in sensor systems on dairy farms. Furthermore, no technical change was found after investment in sensor systems, suggesting that the potential technological improvement claimed by producers of sensor systems does not materialize on dairy farms. Providing more information and guidance on how to use the output of sensor systems might improve the technical performance of the farms. [ABSTRACT FROM AUTHOR]

Broiler houses are an important source of particulate matter (PM) in the Netherlands. High concentrations of PM can threaten the environment and pose health risks to humans and animals. To address these problems, the Dutch government aims to reduce PM 10 emissions originating from broiler houses by 50% between 2020 and 2030. This paper explored broiler farmers' investment preferences for different PM 10 abatement techniques and how they relate to socio-economic characteristics and perceived obstacles for business development. The results of our discrete choice experiment indicate that farmers were reluctant to invest in PM 10 abatement techniques. When they did invest, they had a general preference for techniques with a medium to high (31–52%) rather than a very high PM 10 reduction efficiency (80%). Social factors and perceived obstacles for business development explained heterogeneity in farmers' preferences for PM 10 abatement techniques and their willingness to invest. When investing in abatement techniques, farmers attached a higher relative importance to an exemption from future PM 10 legislation than to a subsidy. The findings imply that more policy-related certainty as well as financial compensation can incentivize farmers to invest in PM 10 abatement. [Display omitted] • Preferences for particulate matter abatement technique attributes were quantified. • Dutch broiler farmers were reluctant to invest in these techniques. • When they did invest, they preferred techniques with a medium reduction efficiency. • They attached a higher relative importance to policy certainty than to a subsidy. • Social factors and perceived obstacles explained heterogeneity in preferences. [ABSTRACT FROM AUTHOR]

Background: Deep vein thrombosis (DVT) after decannulation of extracorporeal life support (ECLS) is not uncommon. Moreover, the impact of anticoagulation and potential risk factors is unclear. Furthermore, it is unclear if cannula‐associated DVT is more common in ECLS patients compared to critically ill patients without ECLS. Methods: All adult patients who were successfully weaned from ECLS and were screened for DVT following decannulation were included in this observational cohort study. The incidence of post‐ECLS‐DVT was assessed and the cannula‐associated DVT rate was compared with that of patients without ECLS after central venous catheter (CVC) removal. The correlation between the level of anticoagulation, risk factors, and post‐ECLS‐DVT was determined. Results: We included 30 ECLS patients and 53 non‐ECLS patients. DVT was found in 15 patients (50%) of which 10 patients had a DVT in a cannulated vein. No correlation between the level of anticoagulation and DVT was found. V‐V ECLS mode was the only independent risk factor for post‐ECLS‐DVT (OR 5.5; 95%CI 1.16–26.41). We found no difference between the ECLS and non‐ECLS cohorts regarding cannula‐associated DVT rate (33% vs. 32%). Conclusion: Post‐ECLS‐DVT is a common finding that occurs in half of all patients supported with ECLS. The incidence of cannula‐associated DVT was equal to CVC‐associated DVT in critically ill patients without ECLS. V‐V ECLS was an independent risk factor for post‐ECLS‐DVT. [ABSTRACT FROM AUTHOR]

This paper analyses the potential gains and the main challenges for increased cross-border collaboration in the control of highly contagious livestock diseases in regions with cross-border reliance on production and consumption of livestock commodities. The aim of this intensification of cross-border collaboration is to retain the economic advantages of cross-border trade in livestock and livestock commodities while maintaining a low risk of highly contagious livestock diseases. From these two foci, possibilities for future policy making with respect to highly contagious livestock diseases are discussed: peacetime cross-border cooperation to improve the cost-effectiveness of routine veterinary measures and crisis time cross-border harmonization of current disease control strategies. A general disease management framework was used to describe the way in which these two fields are related to and affect the epidemiological system and, consequently, how they impact the stakeholders. In addition to this framework, the importance of a good understanding of influencing factors, that is, the production structure of livestock, was stressed because these factors are important determinants of the frequency and magnitude of highly contagious livestock diseases and their economic impact. The use of the suggested integrated approach was illustrated for the extended cross-border region of the Netherlands and Germany, that is, North Rhine Westphalia and Lower Saxony. For this region, current difficulties in cross-border trade in livestock and livestock commodities and possibilities for future cross-border collaboration were examined. The concepts and ideas presented in this paper should foster future development of cross-border collaboration in animal health control. [ABSTRACT FROM AUTHOR]

Highlights: [•] Current prices including subsidies lead to maximum tobacco production and continuous soil degradation. [•] If soil degradation is prohibited, tobacco is replaced partially by beef bulls. [•] Prohibition of further soil degradation decreases the gross margin of a farm by 35%. [•] Abolition of tobacco subsidy results in a stop of soil degradation and GM decrease. [ABSTRACT FROM AUTHOR]

Abstract: Economic analysis of hazard surveillance in livestock production chains is essential for surveillance organizations (such as food safety authorities) when making scientifically based decisions on optimization of resource allocation. To enable this, quantitative decision support tools are required at two levels of analysis: (1) single-hazard surveillance system and (2) surveillance portfolio. This paper addresses the first level by presenting a conceptual approach for the economic analysis of single-hazard surveillance systems. The concept includes objective and subjective aspects of single-hazard surveillance system analysis: (1) a simulation part to derive an efficient set of surveillance setups based on the technical surveillance performance parameters (TSPPs) and the corresponding surveillance costs, i.e., objective analysis, and (2) a multi-criteria decision making model to evaluate the impacts of the hazard surveillance, i.e., subjective analysis. The conceptual approach was checked for (1) conceptual validity and (2) data validity. Issues regarding the practical use of the approach, particularly the data requirement, were discussed. We concluded that the conceptual approach is scientifically credible for economic analysis of single-hazard surveillance systems and that the practicability of the approach depends on data availability. [Copyright &y& Elsevier]

International agreements on plant health and trade require that regulating a pest should be justified by economic impact assessment. Economic impact assessments are usually qualitative, weakening the objective and transparency of the regulation decision. This study assessed the potential economic impacts of the invasion of the plant pathogenic bacterium ' Candidatus Liberibacter solanacearum' into the European Union in order to economically justify a decision on its quarantine status. Direct economic impacts resulting from yield loss in potato and tomato were computed using partial budgeting at a regional scale, while total economic impacts on the potato and tomato markets were computed using partial equilibrium modelling at the EU scale. Annual direct impacts at the most likely infestation level were estimated at €222 m for the whole EU. Uncertainty analysis showed a distribution of foreseeable annual impacts with a 5th percentile of €192 m, and a 95th percentile of €512 m. Increased market prices of potato and tomato resulting from reduced supply were found to increase profits for non-infested producers and to compensate in part for the production losses of infested producers, with consumers paying for this mitigation of impacts on producers. The expected negative impact on societal welfare at the most likely infestation level is less than the estimated direct impacts, viz. €114 m/year. The potential economic impacts of ' Ca. L. solanacearum' in the European Union are demonstrably of major importance. Therefore, a decision to categorize this organism as a quarantine pest is supported. [ABSTRACT FROM AUTHOR]

In the Netherlands, outbreaks of Aujeszky's Disease (AD) are controlled by vaccination and movement restriction zones (MRZ). Although this strategy avoids the socio-ethical concerns associated with pre-emptive slaughter, it can easily result in animal welfare problems and negative economic consequences. These arise because movement restrictions result in surpluses of live (vaccinated) piglets on farms. The aim is to provide insight into the development of these surpluses and its impact and to describe how measures that allow early transportation of pigs under certain conditions and to specific destinations (channelling) could reduce these problems. For the analysis, a deterministic simulation model was developed, which calculates surpluses of piglets at multiplier farms during AD outbreaks. This is performed on a weekly basis for two areas (with and without piglet surplus), three outbreak durations (minimum, moderate and long) and three strategies for movement restrictions (strict, transports within the MRZ allowed and transports outside the MRZ allowed). The results show that in case of complete movement restrictions, surpluses of piglets varying in age and vaccination status will quickly arise. These surpluses are larger for longer epidemics and can become as large as 180-340 thousand piglets (45-75% of weekly domestic production) for moderate and long epidemics, respectively. Implementation of channelling strategies that allow earlier transportation within the MRZ can reduce surpluses by about 50% to 100-150 thousand piglets maximum. Strategies that also allow transportation outside the MRZ can reduce surpluses even further to below 100 thousand piglets. It was concluded that channelling of live piglets during AD outbreaks results in a drastic reduction of problems with accommodating ready-for-transport piglets. Moreover, it reduces shortages during movement restrictions and peak supply immediately after removing the restrictions. Channelling could therefore be an important instrument to reduce the economic and animal welfare impacts of containment measures. [ABSTRACT FROM AUTHOR]

Abstract: Continuous monocropping of tobacco, excessive tillage and inadequate irrigation management have caused soil degradation in tobacco farms in the Valle de Lerma. Soil degradation due to tobacco monocropping and uncertain economic perspectives for tobacco farming call for diversification strategies for tobacco farmers. The objective of this paper is to develop useful criteria for assessing diversification activities and to provide a ranking of different diversification activities on these criteria. The Analytical Hierarchical Process (AHP) technique is applied to get consistent assessments of criteria and activities from experts and stakeholders. Next, goal programming methods are used to aggregate individual assessments in order to arrive at the final ranking of farming activities for diversification. The five criteria to judge production activities for tobacco diversification are contribution to income, suitability for biophysical conditions, availability of technical information, market feasibility and contribution to soil improvement. The feasibility to market the products stands out with clearly high relative weight, while the other criteria received similar weights. The obtained weights of farming activities showed that especially livestock activities and spring–summer crops are important alternatives for tobacco production. Livestock activities stand out because they have high scores on all criteria. Livestock activities and spring–summer crops will compete with tobacco for resources because tobacco is a spring–summer crop. Therefore, these activities may be more suitable for tobacco farms that operate large area of land. The results of this research can be used in optimization models for determining the optimal mix of farming activities in combination with tobacco production. Such models can provide further insights into factors determining diversification. [Copyright &y& Elsevier]

Abstract: The Dutch dairy chain is aiming to achieve energy-neutral production by bringing the whole chain from dairy farm to factory ultimately to be self sufficient in energy in year 2020, through a combination of wind, solar and biogas. This paper investigated the economic feasibility of producing green gas from digestion of dairy manure and other co-substrates. A simulation model of producing 17 PJ of green gas from 2 business models, stand-alone and central upgrading was developed. Probability distributions were chosen to describe the profitability and risks for individual business models and for the aggregate energy production at dairy sector level. Data sources, among others, stem from 23 operating biogas plants in Netherlands. Simulation results showed that the probability of a negative net present value (NPV) is less than 50% for both individual models. The probability that the combined business models producing 17 PJ will result in a negative NPV is 23%. A total of 109 plants are needed to produce the total energy, requiring 8.5% of the total amount of cattle manure produced in the Netherlands to be processed. Sensitivity analysis based on spearman rank correlation coefficient between NPV and each of the sample input distributions showed that biogas yield and investment costs have significant effect in determining the NPV values. [Copyright &y& Elsevier]

We analyse the impacts of direct income transfers on the technical efficiency of Greek olive farms. We use a production frontier function and a non-monotonic inefficiency effects model, which incorporates the influences of exogenous variables (subsidies, farm characteristics, etc.) on technical efficiency. The model is applied to 1995-2004 FADN data. The results show that direct transfers of the CAP had a negative and monotonic effect on technical efficiency, whereas the degree of specialisation had a non-monotonic effect on technical efficiency. [ABSTRACT FROM AUTHOR]

By 2020, Dutch dairy chains envisage to be self-sufficient with regard to energy used by dairy farms and dairy processors. This would require dairy farms to produce 25 PJ per year, possibly by a combination of wind, solar and biogas. This paper focuses on biogas. To evaluate the project's viability we estimated the expected technical and financial performance of 4 types of business models, i.e. "CHP-farm", "CHP-large", "green gas" and "central upgrading of green gas". Data stem from among others 23 biogas plants in the Netherlands. Anticipating that CHP-models and green gas models occur with a likelihood of 40% and 60% respectively, the total number of biogas plants would amount to 232 (1% of dairy farms), including a total of 5 million tons of manure per year (14% of all cattle manure in the Netherlands) and annual government subsidies of Euro 295 million. Aggregated annual profits are expected to be positive, but over the project's total life time there is an expected deficit of Euro 262. For this to change costs of feedstocks or digestate disposal costs would for instance have to go down. Also fully switching to green gas models dampens the deficit. Results are used in current stakeholders debates on the organization of an "energy neutral dairy chain" in the Netherlands. Further analyses incorporating uncertainty around key technical and economic parameters including financial impacts of CO2-reductions are underway. [ABSTRACT FROM AUTHOR]

Evaluating and bridging patients to lung transplantation (LTx) on the intensive care unit (ICU) remains controversial, especially without a previous waitlist status. Long term outcome data after LTx from ICU remains scarce. We compared long-term survival and development of chronic lung allograft dysfunction (CLAD) in elective and LTx from ICU, with or without previous waitlist status. Patients transplanted between 2004 and 2018 in 2 large academic Dutch institutes were included. Long-term survival and development of CLAD was compared in patients who received an elective LTx (ELTx), those bridged and transplanted from the ICU with a previous listing status (BTT), and in patients urgently evaluated and bridged on ICU (EBTT). A total of 582 patients underwent a LTx, 70 (12%) from ICU, 39 BTT and 31 EBTT. Patients transplanted from ICU were younger than ELTx (46 vs 51 years) and were bridged with mechanical ventilation (n = 42 (60%)), extra corporeal membrane oxygenation (n = 28 (40%)), or both (n = 21/28). Bridging success was 48% in the BTT group and 72% in the EBTT group. Patients bridged to LTx on ICU had similar 1 and 5 year survival (86.8% and 78.4%) compared to elective LTx (86.8% and 71.9%). This was not different between the BTT and EBTT group. 5 year CLAD free survival was not different in patients transplanted from ICU vs ELTx. Patients bridged to LTx on the ICU with and without prior listing status had excellent short and long-term patient and graft outcomes, and was similar to patients electively transplanted. [ABSTRACT FROM AUTHOR]

The European Union fosters cooperation in cross-border regions through the European Cohesion Policy (ECP). The implementation of ECP instruments requires a participatory approach, in which stakeholders' views are acknowledged. However, the multiple of views among and between stakeholders of cross-border initiatives complicate their involvement in a participatory approach. A prerequisite for a meaningful involvement of all stakeholders is an in-depth understanding of their viewpoints on what facilitates cross-border cooperation. However, to date, these viewpoints are poorly understood. This study aims to identify and analyse stakeholders' viewpoints on the facilitation of cross-border cooperation. The viewpoints of a sample of entrepreneurs, members of education institutes, and members from local institutions (policymakers and industry representatives) in the Dutch-German cross-border region Rhine-Waal were collected via Q methodology and complemented through interviews. Four viewpoints emerged: cooperation through pro-active engagement, cooperation through targeted policies, cooperation through an aligned institutional setup, and cooperation through socio-cultural proximity. Results can inform policy-making aimed to increase stakeholder involvement in participatory approaches in cross-border regions. [ABSTRACT FROM AUTHOR]

Objectives: In the general critical care patient population, restrictive transfusion regimen of RBCs has been shown to be safe and is yet implemented worldwide. However, in patients on venovenous extracorporeal membrane oxygenation, guidelines suggest liberal thresholds, and a clear overview of RBC transfusion practice is lacking. This study aims to create an overview of RBC transfusion in venovenous extracorporeal membrane oxygenation.Design: Mixed method approach combining multicenter retrospective study and survey.Setting: Sixteen ICUs worldwide.Patients: Patients receiving venovenous extracorporeal membrane oxygenation between January 2018 and July 2019.Interventions: None.Measurements and Main Results: The primary outcome was the proportion receiving RBC, the amount of RBC units given daily and in total. Furthermore, the course of hemoglobin over time during extracorporeal membrane oxygenation was assessed. Demographics, extracorporeal membrane oxygenation characteristics, and patient outcome were collected. Two-hundred eight patients received venovenous extracorporeal membrane oxygenation, 63% male, with an age of 55 years (45-62 yr), mainly for acute respiratory distress syndrome. Extracorporeal membrane oxygenation duration was 9 days (5-14 d). Prior to extracorporeal membrane oxygenation, hemoglobin was 10.8 g/dL (8.9-13.0 g/dL), decreasing to 8.7 g/dL (7.7-9.8 g/dL) during extracorporeal membrane oxygenation. Nadir hemoglobin was lower on days when a transfusion was administered (8.1 g/dL [7.4-9.3 g/dL]). A vast majority of 88% patients received greater than or equal to 1 RBC transfusion, consisting of 1.6 U (1.3-2.3 U) on transfusion days. This high transfusion occurrence rate was also found in nonbleeding patients (81%). Patients with a liberal transfusion threshold (hemoglobin > 9 g/dL) received more RBC in total per transfusion day and extracorporeal membrane oxygenation day. No differences in survival, hemorrhagic and thrombotic complication rates were found between different transfusion thresholds. Also, 28-day mortality was equal in transfused and nontransfused patients.Conclusions: Transfusion of RBC has a high occurrence rate in patients on venovenous extracorporeal membrane oxygenation, even in nonbleeding patients. There is a need for future studies to find optimal transfusion thresholds and triggers in patients on extracorporeal membrane oxygenation. [ABSTRACT FROM AUTHOR]

Intensive broiler production systems are criticized by EU citizens because of their negative impact on animal welfare, the environment and human health. To inform the development of sustainable broiler production systems, this paper provides insight in the synergies and trade-offs between different external factors originating from broiler production systems by developing a new analysis approach. The approach was applied to the Dutch conventional, New Dutch Retail Standard and Extensive Indoor+ systems. The latter two systems have more stringent standards on animal welfare relative to the conventional system. Four external factors were considered, i.e. animal welfare (indicated by Welfare Quality Index score), ammonia emission (kg NH 3 /animal place/year), particulate matter emission (g PM 10 /animal place/year) and antibiotic use (defined daily doses animal). Results show that the shift from a fast-growing breed towards a slower-growing breed caused synergy by improving animal welfare and lowering antibiotic use. Furthermore, the reduction in protein content of the feed, and possibly the reduction in stocking density, caused synergy by enhancing animal welfare and lowering ammonia emission. System changes that stimulated activity, such as the reduction in stocking density, enhanced animal welfare but caused a trade-off with particulate matter emission. Although the New Dutch Retail Standard and Extensive Indoor+ system were characterized by a higher ammonia and particulate matter emission per animal place per year relative to the conventional system, experts estimated that these emissions were partially (New Dutch Retail Standard) or fully (Extensive Indoor+) offset at farm level via a lower stocking density. Overall, we conclude that future development of broiler production systems can exploit the synergy between animal welfare, antibiotic use, and ammonia emission and minimize the trade-off between animal welfare and particulate matter emission. The insights obtained from this paper can support the development of sustainable broiler production systems that minimize external factors originating from these systems. Unlabelled Image • Broiler production systems are criticized because of their negative impact on animal welfare and the environment. • Synergies and trade-offs between external factors originating from Dutch broiler production systems were analyzed. • Synergies were found between animal welfare and antibiotic use, trade-offs between animal welfare and PM 10 emission. • We conclude that future broiler production systems can exploit synergistic effects and minimize the trade-offs. • Insights can support the development of sustainable broiler production systems. [ABSTRACT FROM AUTHOR]