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The need for (nearly) Zero Energy Buildings (nZEBs) becomes increasingly important due to climate change and increasing energy prices. Considering that, on average the existing hospitals use 3.5 times more energy than the nZEB requirement, reaching zero energy a very challenging task. However, monitoring hospitals’ energy flows together with a holistic view on building functions and occupancy can contribute to achieving potential energy savings, which is lacking in the current hospital buildings. Therefore, in this study, the energy saving potentials of a polyclinic building of a hospital in the Netherlands was investigated through a holistic inspection of the building and its occupancy. The analysis is performed in order to investigate the building characteristics, energy supply and demand. It was found that the number of people present was considerably lower than the full capacity, with 30% average occupancy in the medical facilities and 70% for the administrative areas. The air supply of the current ventilation system was found to be constant irrespective of the number of people present in these rooms. Furthermore, a discrepancy of 30- 50% was found between designed and installed lighting systems. The analysis of the polyclinic showed possible energy-saving measures with controlled ventilation rates and lighting according to the occupancy.

The need for (nearly) Zero Energy Buildings (nZEBs) in the Netherlands becomes increasingly important due to climate change, increasing energy prices, scarcity of fossil fuels and increasing geopolitical conflicts. In line with the EU EPBD, from 2020 new buildings, including hospital and university buildings, have to fulfil more strict energy requirements. Besides that, also the energy requirements for existing buildings will become stricter to realize an energy neutral built environment in 2050. On request of the Dutch Universities (WO) and the Dutch Academic Medical Centre’s (UMC), the Netherlands Enterprise Agency (RVO) assigned Royal HaskoningDHV to study the effect of the preliminary nZEB requirements on the real estate of the sector [1]. The feasibility of the nZEB requirements has been assessed for several representative, recently designed or realized buildings. For the selected hospital and university buildings, the results show that the preliminary nZEB requirements are not yet fulfilled. The requirement that 50% of building related energy should be of a local renewable energy source seems not to be feasible for both hospital and university buildings. Based on the results and recommendations of the study, a letter to the Dutch minister of the Ministry of the Interior and Kingdom Relations was sent and included a strong request to incorporate these in the definitive nZEB requirements, which will be set at the end of 2018.

Introduction: Accurate and standardized phenotypic descriptions are essential in diagnosing rare diseases and discovering new diseases, and the Human Phenotype Ontology (HPO) system was developed to provide a rich collection of hierarchical phenotypic descriptions. However, although the HPO terms for inborn errors of immunity have been improved and curated, it has not been investigated whether this curation improves the diagnosis of systemic autoinflammatory disease (SAID) patients. Here, we aimed to study if improved HPO annotation for SAIDs enhanced SAID identification and to demonstrate the potential of phenotype-driven genome diagnostics using curated HPO terms for SAIDs., Methods: We collected HPO terms from 98 genetically confirmed SAID patients across eight different European SAID expertise centers and used the LIRICAL (Likelihood Ratio Interpretation of Clinical Abnormalities) computational algorithm to estimate the effect of HPO curation on the prioritization of the correct SAID for each patient., Results: Our results show that the percentage of correct diagnoses increased from 66% to 86% and that the number of diagnoses with the highest ranking increased from 38 to 45. In a further pilot study, curation also improved HPO-based whole-exome sequencing (WES) analysis, diagnosing 10/12 patients before and 12/12 after curation. In addition, the average number of candidate diseases that needed to be interpreted decreased from 35 to 2., Discussion: This study demonstrates that curation of HPO terms can increase identification of the correct diagnosis, emphasizing the high potential of HPO-based genome diagnostics for SAIDs., Competing Interests: MH is currently employed by Boehringer Ingelheim RCV GmbH & Co KG. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Maassen, Legger, Kul Cinar, van Daele, Gattorno, Bader-Meunier, Wouters, Briggs, Johansson, van der Velde, Swertz, Omoyinmi, Hoppenreijs, Belot, Eleftheriou, Caorsi, Aeschlimann, Boursier, Brogan, Haimel and van Gijn.)

Background: The German Military Medical Service contributed to the medical screening of unaccompanied minor refugees (UMRs) coming to Germany in 2014 and 2015. In this study, a broad range of diagnostic procedures was applied to identify microorganisms with clinical or public health significance. Previously, those tests had only been used to screen soldiers returning from tropical deployments. This instance is the first time the approach has been studied in a humanitarian context., Methods: The offered screenings included blood cell counts, hepatitis B serology and microscopy of the stool to look for protozoa and worm eggs as well as PCR from stool samples targeting pathogenic bacteria, protozoa and helminths. If individuals refused certain assessments, their decision to do so was accepted. A total of 219 apparently healthy male UMRs coming from Afghanistan, Egypt, Somalia, Eritrea, Syria, Ghana, Guinea, Iran, Algeria, Iraq, Benin, Gambia, Libya, Morocco, Pakistan, and Palestine were assessed. All UMRs who were examined at the study department were included in the assessment., Results: We detected decreasing frequencies of pathogens that included diarrhoea-associated bacteria [C ampylobacter (C.) jejuni , enteropathogenic Escherichia (E.) coli (EPEC), enterotoxic E. coli (ETEC), enteroaggregative E. coli (EAEC), enteroinvasive E. coli (EIEC)/ Shigella spp.), Giardia (G.) duodenalis , helminths (comprising Schistosoma spp., Hymenolepis (H.) nana , Strongyloides (S.) stercoralis ] as well as hepatitis B virus. Pathogenic microorganisms dominated the samples by far. While G. duodenalis was detected in 11.4% of the assessed UMRs, the incidence of newly identified cases in the German population was 4.5 cases per 100,000 inhabitants., Conclusions: We conclude that the applied in-house PCR screening systems, which have proven to be useful for screening military returnees from tropical deployments, can also be used for health assessment of immigrants from the respective sites. Apparently healthy UMRs may be enterically colonized with a broad variety of pathogenic and apathogenic microorganisms. Increased colonization rates, as shown for G. duodenalis, can pose a hygiene problem in centralized homes for asylum seekers.

Introduction. Since 2013, European soldiers have been deployed on the European Union Training Mission (EUTM) in Mali. From the beginning, diarrhea has been among the most "urgent" concerns. Diarrhea surveillance based on deployable real-time PCR equipment was conducted between December 2013 and August 2014. Material and Methods. In total, 53 stool samples were obtained from 51 soldiers with acute diarrhea. Multiplex PCR panels comprised enteroinvasive bacteria, diarrhea-associated Escherichia coli (EPEC, ETEC, EAEC, and EIEC), enteropathogenic viruses, and protozoa. Noroviruses were characterized by sequencing. Cultural screening for Enterobacteriaceae with extended-spectrum beta-lactamases (ESBL) with subsequent repetitive sequence-based PCR (rep-PCR) typing was performed. Clinical information was assessed. Results. Positive PCR results for diarrhea-associated pathogens were detected in 43/53 samples, comprising EPEC (n = 21), ETEC (n = 19), EAEC (n = 15), Norovirus (n = 10), Shigella spp./EIEC (n = 6), Cryptosporidium parvum (n = 3), Giardia duodenalis (n = 2), Salmonella spp. (n = 1), Astrovirus (n = 1), Rotavirus (n = 1), and Sapovirus (n = 1). ESBL-positive Enterobacteriaceae were grown from 13 out of 48 samples. Simultaneous infections with several enteropathogenic agents were observed in 23 instances. Symptoms were mild to moderate. There were hints of autochthonous transmission. Conclusions. Multiplex real-time PCR proved to be suitable for diarrhea surveillance on deployment. Etiological attribution is challenging in cases of detection of multiple pathogens.

The role of surgical treatment of non-small-cell carcinoma of the lung is controversial. Surgical therapy of small cell carcinoma of the lung has been the subject of criticism for two decades - in contrast to our opinion about the important role of initial surgical therapy in limited disease of this type of lung carcinoma. In a review of the results of surgical therapy in 109 patients with undifferentiated small cell carcinoma of the lung in the period from 1962 to 1979 and an attempt to define the role of the curative effect, we report on 109 thoracotomies after negative preoperative mediastinoscopy and exclusion of hematogenous spread of the cancer. The resection rate (94/109) was considerably lower than in differentiated lung carcinoma. Pneumonectomy (40%) and extended pneumonectomy (27%) were more frequently performed for small cell carcinoma than for differentiated tumors; thus, the rate of lobectomy and segmental resection (28/94 = 30%, and 3/94 = 3%, respectively) was low. When we included the postoperative lethality in the calculation rather than using the life-table method, we found in a follow-up study of 99% of the patients who had undergone resection, in absolute numbers, 3-year survival in 21/93 patients (23%). In the different stages I, II, and III, we noted 3-year survival rates of 32%, 25%, and 14%. Correlation to the N and T stages was N0 (10/29) 35%; N1 (6/34) 18%; N2 (5/30), 17%; N1 + 2 (11/64) 17%; T1 (11/28) 39%; T2 (8/35) 23%; T3 (2/30) 7%; and T2 + 3 (9/34) 14%.(ABSTRACT TRUNCATED AT 250 WORDS)

Between 1962 and 1974, out of 642 patients operated on for bronchial carcinoma, 89% were resected and in 11% of the cases the operation was concluded as an exploratory thoracotomy. If the expansion of the tumor was limited, even undifferentiated carcinoma had a favorable prognosis. After 5 years 53% of the patients with the histological diagnosis of a squamous celll carcinoma, 46% of a small-cell carcinoma and 40% of an undifferentiated medium and large-cell carcinoma were alive, if the tumors belonged to the T1 stage. It is emphasized that strong selective preoperative criteria, including mediastinoscopy, are necessary.

The aims of this study were to investigate whether a relevant functional improvement before and after bullectomy was achieved in cases of a localized bulla and generalized bullous changes early and late postoperatively and to establish clear criteria for bullectomy. For this purpose, 21 patients with a localized bulla compressing the rest of the lung, and 19 with generalized bullae with emphysematous changes of the remaining lung were examined before and after (1 1/2 months and 1 1/2 years) surgery. Comparison of the preoperative and postoperative data and the follow-up included X-ray studies with planimetric assessment of the size of the bullae, lung function tests, perfusion scintigrams and clinical findings. The preoperative and postoperative statistical values of lung volume and respiratory mechanics showed the most significant differences. Bullectomy for a localized bulla with compression of the rest of the lung led to an improvement in gas exchange and respiratory mechanics. This operation, however, produced no functional improvement in cases of generalized bullous changes. Functional and clinical success is greater, the larger and more delimited the bulla is to be seen on X-ray, the more the healthy lung tissue is compressed, and, finally, the less associated diseases such as chronic bronchitis are present. Indication for bullectomy should be limited to these cases. The size of the bulla should amount to at least 2/3 of the hemithorax, preoperative function should be clearly reduced and the patient should be suffering from dyspnea.