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Although observational cohort studies report that interventions to achieve functionality are clinically successful in 85% of patients, the proportion of newly created autologous arteriovenous fistulas that result in functional vascular access typically is only 70 – 80%. To address this discrepancy, the selection and outcomes of interventions to achieve functionality in a multicentre prospective cohort study were analysed. The Shunt Simulation Study enrolled 222 patients who needed a first arteriovenous fistula in nine dialysis units in The Netherlands from 2015 to 2018 and followed these patients until one year after access creation. In this observational study, the technical and clinical success rates of interventions to achieve functionality based on lesion and intervention characteristics were analysed and the clinical outcomes of arteriovenous fistulas with assisted and unassisted functionality were compared. For patients who were on dialysis treatment at the end of the study, unassisted fistula functionality was 54% and overall fistula functionality was 78%. Thirty-four per cent of arteriovenous fistulas required an intervention to achieve functionality, 68% of which eventually became functional. Seventy-five per cent of these interventions were percutaneous balloon angioplasties of vascular access stenoses. Patients with clinically successful interventions to achieve functionality had larger pre-operative vein diameters (2.8 ± 1.0 mm vs. 2.3 ± 0.6 mm, p =.036) and less often presented with thrombosed fistulas than patients with unsuccessful interventions (7% vs. 43%, p =.006). Arteriovenous fistulas with assisted functionality had similar secondary patency as fistulas with unassisted functionality (100% and 98% at six months, p =.44), although they required more interventions to maintain function (2.6 vs. 1.7 per year; rate ratio 1.52, 95% CI 1.04 – 2.18, p =.032). Interventions to achieve functionality were needed in about a third of newly created arteriovenous fistulas. Most thrombosed fistulas were abandoned, and when selected for thrombectomy rarely reached clinical success. On the other hand, interventions to achieve functionality of patent fistulas had high clinical success rates and therefore can be done repeatedly until the fistula has become functional. [ABSTRACT FROM AUTHOR]

Multi-use is advocated as an approach to facilitate growth of the blue economy. However, multi-use and blue economy research and policy have been critiqued for their focus on large-scale development, which raises questions about implications for small-scale ocean and coastal users. This research constitutes an exploratory, qualitative study of marine users' multi-use experiences in Rhode Island, U.S. We conducted focus groups with 31 small operators in the aquaculture, commercial fishing, marine recreation, marine charters/tours/education, recreational boating/sailing, and recreational/charter fishing sectors. Thematic analysis of interviews revealed six themes and associated sub-themes synthesizing participants' experiences. Results revealed that participants envisioned limited multi-use opportunities. Participants' predominant multi-use experiences were characterized by involuntary coexistence, conflict and competition; they resisted hard uses and were more receptive to soft uses. Further, we found that inadequate coastal and water access was a multi-use barrier, and that governance arrangements either facilitated or limited multi-use. Overall, results reveal users' limited experience with and openness to multi-use. They provide important insights into the nuances of coexistence and use conflicts, some of which are deep-rooted and not easily resolved. Our findings elucidate the social implications of multi-use and blue economy approaches and suggest a disconnect between these approaches and users' lived experiences. Recommendations include research that further investigates users' multi-use experiences and attitudes, as well as the implementation of multi-use and blue economy policies and practices that are inclusive of small-scale ocean and coastal users. • Reports exploratory research on user multi-use experiences in Rhode Island, U.S. • Focuses on small operators in sectors including aquaculture, recreation and fishing. • Findings reveal users experience involuntary coexistence, conflict and competition. • Users resist new, hard uses and identify access and governance as multi-use barriers. • Identifies disconnect between multi-use and blue economy and user experience. [ABSTRACT FROM AUTHOR]

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Collaboration across different disciplines (interdisciplinary collaboration) is necessary for frame-breaking innovations. However, successfully implementing such often requires individuals to sample ideas outside their disciplinary knowledge. In the past, studies tend to show that individuals inevitably show bias in using their disciplinary knowledge due to disciplinary socialization. The current research proposes that disciplinary centrism is not inevitable and can be attenuated when participants do not perceive disciplinary values across disciplines to have incommensurable differences. In an eye-tracking experiment, I show that participants who held a high (versus low) perception of value differences across disciplinary knowledge would focus on their disciplinary information more (versus less) during the information sampling stage in a creativity task. The study provides implications on how to improve interdisciplinary collaboration and highlights how information is being selected and used in the informational processing stage during a creative task. [ABSTRACT FROM AUTHOR]

Donor human milk (DHM) is recommended as the first alternative for preterm infants if their mother's own milk is not available or if the quantity is not sufficient. The most commonly used technique to eliminate microbial contaminants in DHM is holder pasteurization (HoP). However, the heating process during HoP partially destroys milk bioactive factors such as insulin. Therefore, innovative techniques have been developed as alternatives to HoP. The objective of this study was to determine the effect of HoP, high-temperature–short-time (HTST), thermoultrasonication (TUS), ultraviolet-C irradiation (UV-C), and high-pressure processing (HPP) on the insulin concentration in DHM. Milk samples from 28 non-diabetic mothers were collected. The milk samples were aliquoted and either left untreated or treated with HoP (62.5 °C; 30 min), HTST (72 °C; 15 s), TUS (60 W; 6 min), UV-C (4863 J/L), or HPP (500 MPa; 5 min). The mean insulin concentration in untreated milk was 79 ± 41 pmol/L. The mean insulin retention rate was 67% for HoP, 78% for HTST, 97% for TUS, 94% for UV-C, and 106% for HPP. The mean insulin concentration in milk treated with HoP was significantly lower compared to untreated milk (p = 0.01). TUS, UV-C, and HPP preserve insulin in DHM. The insulin concentration in DHM is affected to a larger extent by HoP than by HTST. These results indicate that TUS, UV-C, and HPP may serve as alternatives to HoP. [ABSTRACT FROM AUTHOR]

Drugs with anticholinergic properties are associated with an increased prevalence of delirium, especially in older persons. The aim of this study was to evaluate the association between the use of this class of drugs in nursing home (NH) patients and prevalence of delirium, particularly in people with dementia. Cross-sectional multicenter study. 3924 nursing home patients of 57 nursing homes in 7 European countries participating in the Services and Health for Elderly in Long TERmcare (SHELTER) project. Descriptive statistics, calculation of percentage, and multivariable logistic analysis were applied to describe the relationship between anticholinergic drug use and prevalence of delirium in NH patients. The Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB) were used to calculate the anticholinergic load. 54% of patients with dementia and 60% without dementia received at least 1 anticholinergic drug according to the ACB. The prevalence of delirium was higher in the dementia group (21%) compared with the nondementia group (11%). Overall, anticholinergic burden according to the ACB and ARS was associated with delirium both in patients with and without dementia, with odds ratios ranging from 1.07 [95% confidence interval (CI) 0.94-1.21] to 1.26 (95% CI 1.11-1.44). These associations reached statistical significance only in the group of patients with dementia. Among patients with dementia, delirium prevalence increased only modestly with increasing anticholinergic burden according to the ACB, from 20% (with none or minimal anticholinergic burden) to 25% (with moderate burden) and 27% delirium (with strong burden scores). The ACB scale is relatively capable to detect anticholinergic side effects, which are positively associated with prevalence of delirium in NH patients. Given the modest nature of this association, strong recommendations are currently not warranted, and more longitudinal studies are needed. [ABSTRACT FROM AUTHOR]

Experimental (nutritional) interventions in preterm infants frequently focus on intestinal maturation, as improving tolerance to enteral nutrition is a major goal. Intestinal permeability and lactase activity serve as markers for intestinal maturation. We aimed to develop a protocol for the simultaneous assessment of both markers in human-milk-fed preterm infants by a sugar absorption test. In addition, we developed a new gas chromatography-mass spectrometry (GC–MS) method for the analysis of lactulose, lactose, and mannitol in urine and milk collected during the sugar absorption test. The sugar absorption test was performed on days 4, 7, and 14 postpartum in 12 preterm infants (gestational age of 26–32 weeks). Human milk was collected, pooled, and divided into equal portions to provide a stable lactose intake for 24 h. Urine was collected in the last 6 h of this 24 h period, after administration of a bolus test sugar solution. Samples were analyzed by GC–MS after derivatization by oxime formation combined with acetylation. The GC–MS method was validated and used for the accurate measurement of lactulose, lactose, and mannitol concentrations. The urinary lactulose/mannitol ratio declined with time, suggesting a decreased intestinal permeability. The urine-to-milk-lactulose/lactose ratio increased as a result of increased lactase activity with time. The developed protocol for simultaneous assessment of intestinal permeability and lactase activity can be used to monitor the effect of experimental (nutritional) interventions in human-milk-fed preterm infants. Urine and milk samples obtained during the sugar absorption test can be accurately analyzed by GC–MS. [ABSTRACT FROM AUTHOR]

It is generally taken for granted that the bulk minority carrier lifetime in uncompensated phosphorus-doped silicon (Si) wafers is stable under illumination. In contradiction with this long-time belief, we report on a fast and significant lifetime degradation under light soaking for Czochralski wafers sampled from the top ingot end. We demonstrate that defect formation also proceeds during carrier injection by forward biasing Si heterojunction solar cells made from such wafers, suggesting a carrier-induced degradation rather than merely light-induced. The involved bulk defect is shown to preferentially form at the wafer center, where double Thermal Donors are in high concentration. The role of Thermal Donors is investigated further and the obtained preliminary results support their involvement in the reported carrier-induced degradation. [ABSTRACT FROM AUTHOR]

Major impurity-induced defects in Czochralski silicon are known to be related to oxygen and metallic elements. In this study we focus on seed-end wafers, and submit them to different solar cell process-related annealings. We find that in the as-received state, these seed-end wafers contain a central low carrier lifetime core. We demonstrate that the effective carrier lifetime in the as-received state is simultaneously governed by several defects including oxygen-related thermal donors and a defect deactivated at low temperature. After high temperature steps, a strong recombination center is formed in the central core. Preliminary results of effective carrier lifetime versus temperature measurements directly support oxygen precipitates to be limiting the carrier lifetime. In the light of all results, we propose a qualitative model for the high temperature behavior of these seed-end wafers. [ABSTRACT FROM AUTHOR]

Cystic echinococcosis (CE) is an important helminthic zoonotic disease that commonly affects the liver and lungs. Imaging methods and serology establish the diagnosis in most cases. Chest x-ray can diagnose uncomplicated pulmonary hydatid cysts, whereas superinfection and/or rupture of the hydatid cyst (complicated cysts) may change the radiographic appearance and lead to delayed diagnosis and treatment. We report the case of a patient with hemoptysis and chest pain, where computer tomography scan of the lung suggested a large, ruptured hydatid cyst. However, serological tests with indirect hemagglutination (IHA)for Echinococcus granulosus antibodies were negative, and there was massive growth of Streptococcus pneumoniae in sputum. Based on this, we concluded that the patient had a bacterial lung abscess. The diagnosis of CE was only made after surgical removal of the cyst followed by microscopy and polymerase chain reaction. [ABSTRACT FROM AUTHOR]

Abstract: An understanding of the complex phenomena involved in droplet combustion, such as two-phase flows and heat/mass transfer, is a necessary step towards improving combustion efficiency and reducing pollutant emissions. This paper is focused on an analysis of the droplet temperature evolution across the flame front in two-phase flow systems. In this experiment, the flame was stabilized on a rod at atmospheric pressure and the fuel was liquid at injection, which implies the presence of fuel droplets close to the flame front. However the flame was partially premixed because part of the fuel vaporized quickly and contributed to the stabilization of the flame. The configuration was two-dimensional and so called “V-shape” flame. Two different flow conditions were investigated: a pseudo-laminar flow as the reference case (R) and a low-turbulence level flow (LT). The evolution of the mean fuel droplet temperature across the flame brush was quantified. The shape of the fuel droplet temperatures histogram became clearly bimodal for high values of the mean progress variable , indicating the presence of droplets in the measurement volume that were heated up by the burnt gases and the flame. The temperature evolution and the statistics across the flame front can be used to compare the numerical and the physical models applied to two-phase combustion. [Copyright &y& Elsevier]

Although RNA interference (RNAi) has become a ubiquitous laboratory tool since its discovery 12 years ago, in vivo delivery to selected cell types remains a major technical challenge. Here, we report the use of lentiviral vectors for long-term in vivo delivery of RNAi selectively to resident alveolar macrophages (AMs), key immune effector cells in the lung. We demonstrate the therapeutic potential of this approach by RNAi-based downregulation of p65 (RelA), a component of the pro-inflammatory transcriptional regulator, nuclear factor κB (NF-κB) and a key participant in lung disease pathogenesis. In vivo RNAi delivery results in decreased induction of NF-κB and downstream neutrophilic chemokines in transduced AMs as well as attenuated lung neutrophilia following stimulation with lipopolysaccharide (LPS). Through concurrent delivery of a novel lentiviral reporter vector (lenti-NF-κB-luc-GFP) we track in vivo expression of NF-κB target genes in real time, a critical step towards extending RNAi-based therapy to longstanding lung diseases. Application of this system reveals that resident AMs persist in the airspaces of mice following the resolution of LPS-induced inflammation, thus allowing these localized cells to be used as effective vehicles for prolonged RNAi delivery in disease settings. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores the ignition and subsequent evolution of spray flames in a bluff-body configuration with and without swirl. Ethanol and n-heptane are used to compare the effects of volatility. Ignition is performed by a laser spark. High speed imaging of OH*-chemiluminescence and OH-PLIF collected at 5kHz are used to investigate the behaviour of the flames during the first stages of ignition and the stable flame structure following ignition. Swirl induces a wider and shorter flame, precession, and multiple reaction zones, while the non-swirling flames have a simpler structure. The reaction fronts seem thinner with ethanol than with heptane. The dataset can be used for model validation. [Copyright &y& Elsevier]

The loss of muscle mass with aging has been, at least partly, attributed to a blunted muscle protein synthetic response to food intake. Leucine coingestion has been reported to stimulate postprandial insulin release and augment postprandial muscle protein accretion. We assessed the clinical benefits of 6 mo of leucine supplementation in elderly, type 2 diabetes patients. Sixty elderly males with type 2 diabetes (age, 71 ± 1 y; BMI, 27.3 ± 0.4 kg/m2) were administered 2.5 g L-leucine (n = 30) or a placebo (n = 30) with each main meal during 6 mo of nutritional intervention (7.5 g/d leucine or placebol. Body composition, muscle fiber characteristics, muscle strength, glucose homeostasis, and basal plasma amino acid and lipid concentrations were assessed prior to, during, and after intervention. Lean tissue mass did not change or differ between groups and at 0,3, and 6 mo were 61.9 ± 1.1, 62.2 ± 1.1, and 62.0 ± 1.0 kg, respectively, in the leucine group and 62.2 ± 1.3, 62.2 ± 1.3, and 62.2 ± 1.3 kg in the placebo group. There also were no changes in body fat percentage, muscle strength, and muscle fiber type characteristics. Blood glycosylated hemoglobin did not change or differ between groups and was 7.1 ± 0.1 % in the leucine group and 7.2 ± 0.2% in the placebo group. Consistent with this, oral glucose insulin sensitivity and plasma lipid concentrations did not change or differ between groups. We conclude that prolonged leucine supplementation 17.5 g/d) does not modulate body composition, muscle mass, strength, glycemic control, and/or lipidemia in elderly, type 2 diabetes patients who habitually consume adequate dietary protein. [ABSTRACT FROM AUTHOR]

Abstract: In order to support drivers in forming the right expectations on the road, road categories are being made recognisable and predictable in the Netherlands. The present study investigated which of the selected road layouts can make rural road categories most recognisable for road users, especially in transitions from one road category to another. A second objective was to study whether explicit information could contribute to a better recognisability of transitions. The experiment was performed with a series of photographs showing sections of two road categories with an intersection in between. The road layout of road categories varied in markings and separation of driving direction (within-subjects factor). Informed and non-informed participants (between-subjects factor) had to indicate their expectations regarding speed limit and access restriction of each road section, before and after a transition. The results show that for transitions between distributor and through roads, the physicality of separation of driving direction is a better distinctive characteristic than the currently used edge marking. The green centre marking on through roads also enhances recognisability, but only with additional information. As far as transitions between distributor and access roads are concerned, the results demonstrate that this type of transitions is better recognised when no markings on access roads are present. Physical separation of driving directions on distributor roads also improves recognisability, although this layout is associated with higher speed limits. Providing explicit information has in general a positive effect on the reconisability of transitions. Implications are discussed in the light of potential safety effects. [ABSTRACT FROM AUTHOR]

Abstract: Emission spectra from electrical and laser sparks in flowing methane–air mixtures of various compositions have been collected and analysed. The differences and similarities between the electrical and laser sparks in the context of their emission are discussed. The emission spectra from the laser spark were characterized by a weak continuum, onto which several strong atomic lines and some molecular bands were superimposed, in contrast to the spectra of electrical spark where a strong continuum, few atomic lines and several strong molecular bands were evident, making thus the laser spark spectroscopy a more accurate technique to measure hydrocarbon concentration. For both types of spark, the total intensity of the CN chemiluminescence around 388nm was found to correlate almost linearly with fuel concentration in methane–air mixtures. [Copyright &y& Elsevier]

Abstract: This study assessed the effectiveness of a Teaching Interaction procedure for four social skills across three participants diagnosed with autism. All social skills fell into four broad domains (i.e., social-communication, play, emotion skills, and choice/selection skills). In addition, a teaching package was used to increase communication between the three participants and three selected target peers. The teaching package consisted of the Teaching Interaction procedure, reinforcement, and priming of participants to demonstrate social skills and to engage with their target peers. Prior to intervention, participants displayed near zero levels of the four social skills that were targeted; after intervention, all three participants were able to demonstrate these skills. Prior to intervention, participants did not communicate or play with their selected target peer; after intervention, participants were able to increase the amount of play and communication. A multiple baseline design showed that the teaching package was effective in teaching both the targeted social skills and in increasing the development of initial associations that could lead to friendships for three children diagnosed with autism. [Copyright &y& Elsevier]

Abstract: Although road safety has improved enormously over time, and The Netherlands is one of the safest countries in the world, the current annual number of road casualties is still considered as unacceptable. To support next steps the sustainable safety vision was launched in the early 1990s. The idea was to make the Dutch road traffic system inherently safe. Sustainable safety was the guide in the approach of improving road safety in The Netherlands the last two decades. Because implemented sustainable safety measures reduced the number of casualties, the vision can be considered as successful. More than a decade later, SWOV Institute for Road Safety Research judged the time ready for evaluating and updating the original Sustainable Safety vision. The advanced sustainable safety vision is meant to inspire the road safety community and all tiers of government in the way they may improve road safety in the coming 15 to 20 years. This paper presents the (theoretical) core of the advanced sustainable safety vision: the aims of preventing crashes, and where this is not possible, to reduce the chance of severe injury to (almost) zero; the proactive approach to reach this, with ‘man as the measure of all things’ as a starting point, in a balanced combination of the elements ‘road’, ‘vehicle’, and ‘man’. In the sustainable safety vision, five principles are central now: functionality of roads, homogeneity of masses and/or speed and direction, predictability of road course and road user behaviour by a recognizable road design, forgivingness of the environment and of road users, and state awareness by the road user. The vision has been translated into numerous ideas for practical proposals. Special attention is paid to implementation of these proposals given the political and governmental context of The Netherlands. [Copyright &y& Elsevier]

Summary: Objective: To study the reliability and validity of a scoring instrument for the assessment of neonatal resuscitation skills in a training setting. Methods: Fourteen paediatric residents performed a neonatal resuscitation on a manikin, while being recorded with a video camera. The videotapes were analysed using an existing scoring instrument with an established face and content validity, adjusted for use in a training setting. Intra- and inter-rater reliability were assessed by comparing the ratings of the videotapes of three raters, one of who rated the videotapes twice. Intra-class coefficients (ICC) were calculated for the sum score, percentages of agreement and kappa coefficients for the individual items. To study construct validity, the performance of a second resuscitation of by residents was assessed after they had received feedback on their first performance. Results: The ICC were 0.95 and 0.77 for intra- and inter-rater reliability, respectively. The median percentage of intra-rater agreement was 100%; inter-rater agreement 78.6–84.0%. The median kappa was 0.85 for intra-rater reliability, and 0.42–0.59 for inter-rater reliability. Residents showed a 10% improvement (95% confidence interval −4; 23%) on performance of a second resuscitation, which supports the instrument''s construct validity. Conclusion: A useful and valid instrument with good intra-rater and reasonable inter-rater reliability is now available for the assessment of neonatal resuscitation skills in a training setting. Its reliability can be improved by using a more advanced manikin and by training of the raters. [Copyright &y& Elsevier]

Abstract: Driving speed is an important factor in road safety. Speed not only affects the severity of a crash, but is also related to the risk of being involved in a crash. This paper discusses the most important empirical studies into speed and crash rate with an emphasis on the more recent studies. The majority of these studies looked at absolute speed, either at individual vehicle level or at road section level. Respectively, they found evidence for an exponential function and a power function between speed and crash rate. Both types of studies found evidence that crash rate increases faster with an increase in speed on minor roads than on major roads. At a more detailed level, lane width, junction density, and traffic flow were found to interact with the speed–crash rate relation. Other studies looked at speed dispersion and found evidence that this is also an important factor in determining crash rate. Larger differences in speed between vehicles are related to a higher crash rate. Without exception, a vehicle that moved (much) faster than other traffic around it, had a higher crash rate. With regard to the rate of a (much) slower moving vehicle, the evidence is inconclusive. [Copyright &y& Elsevier]

OBJECTIVE: Noninvasive prenatal testing (NIPT) is a recently developed risk-assessment technique with high sensitivity and specificity for fetal aneuploidy. The effect NIPT has had on traditional screening and diagnostic testing has not been clearly demonstrated. In this study, NIPT uptake and subsequent changes in the utilization of first-trimester screen (FTS), chorionic villus sampling (CVS), and amniocentesis in a single referral center is reported. STUDY DESIGN: Monthly numbers of NIPT (in high-risk patients), FTS, CVS, and amniocentesis were compared between a 35-month baseline period (April 2009 through February 2012) before introduction of NIPT, and the initial 16 months following NIPT introduction divided in 4-month quarters beginning in March 2012 through June 2013. RESULTS: A total of 1265 NIPT, 6637 FTS, 251 CVS, and 1134 amniocentesis were recorded over the 51-month study period in singleton pregnancies of women who desired prenatal screening and diagnostic testing. NIPT became the predominant FTS method by the second quarter following its introduction, increasing by 55.0% over the course of the study period. Total first-trimester risk assessments (NIPT+FTS) were not statistically different following NIPT (P = .312), but average monthly FTS procedures significantly decreased following NIPT introduction, decreasing by 48.7% over the course of the study period. Average monthly CVS and amniocentesis procedures significantly decreased following NIPT introduction, representing a 77.2% and 52.5% decrease in testing, respectively. Screening and testing per 100 morphological ultrasounds followed a similar trend. CONCLUSION: NIPT was quickly adopted by our high-risk patient population, and significantly decreased alternate prenatal screening and diagnostic testing in a short period of time. [ABSTRACT FROM AUTHOR]