Search

Item does not contain fulltext, BACKGROUND: Concerns have been raised regarding the risks of SARS-CoV-2 breakthrough infections in vaccinated patients with immune-mediated inflammatory diseases treated with immunosuppressants, but clinical data on breakthrough infections are still scarce. The primary objective of this study was to compare the incidence and severity of SARS-CoV-2 breakthrough infections between patients with immune-mediated inflammatory diseases using immunosuppressants, and controls (patients with immune-mediated inflammatory diseases not taking immunosuppressants and healthy controls) who had received full COVID-19 vaccinations. The secondary objective was to explore determinants of breakthrough infections of the delta (B.1.617.2) variant of SARS-CoV-2, including humoral immune responses after vaccination. METHODS: In this substudy, we pooled data collected in two large ongoing prospective multicentre cohort studies conducted in the Netherlands (Target to-B! [T2B!] study and Amsterdam Rheumatology Center COVID [ARC-COVID] study). Both studies recruited adult patients (age ≥18 years) with immune-mediated inflammatory diseases and healthy controls. We sourced clinical data from standardised electronic case record forms, digital questionnaires, and medical files. We only included individuals who were vaccinated against SARS-CoV-2. For T2B!, participants were recruited between Feb 2 and Aug 1, 2021, and for ARC-COVID, participants were recruited between April 26, 2020, and March 1, 2021. In this study we assessed data on breakthrough infections collected between July 1 and Dec 15, 2021, a period in which the delta SARS-CoV-2 variant was the dominant variant in the Netherlands. We defined a SARS-CoV-2 breakthrough infection as a PCR-confirmed or antigen test-confirmed SARS-CoV-2 infection that occurred at least 14 days after vaccination. All breakthrough infections during this period were assumed to be due to the delta variant due to its dominance during the study period. We analysed

Although asthma is very common, affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world, which results in both over- and under-diagnosis. A taskforce was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendations for clinical practice. The taskforce defined eight Population, Index, Comparator and Outcome questions that were assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. The taskforce utilised the outcomes to develop an evidence-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences. The taskforce supports the initial use of spirometry followed by bronchodilator reversibility testing (if airway obstruction is present). If initial spirometry fails to show obstruction, further tests should be performed in the following order: exhaled nitric oxide fraction, peak expiratory flow variability, or, in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms. The taskforce reinforces spirometry as a priority and recognises the value of measuring blood eosinophils and serum immunoglobulin E to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved forced expiratory volume in 1 s/forced vital capacity ratio deserves further attention. The taskforce draws attention to the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids; the comorbidities that may obscure diagnosis; the importance of phenotyping; and the necessity of considering the patient experience in the diagnostic process.

Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro-immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways.

Contains fulltext : 233257.pdf (Publisher’s version ) (Open Access)

The TCFD-guidelines were created to support companies, investors and other financial service providers in better identifying and addressing climate-related risks and opportunities. They differ from current disclosure practices by addressing the impact of climate change on business rather than the impact of businesses on the climate. They also aim to address a long-term time horizon by using scenario analysis. The current adoption rate of scenario analysis, however, is relatively low because there is no standardized method, tool or set of guidelines for the application hereof. Also there has been little research into the added value of scenario analysis in this process. The aim of this this research is to find the added value of scenario analysis to the TCFD-guidelines by developing, testing and disclosing a new practical method for this purpose. The method is developed by conducting a literature review and expert interviews and subsequently tested and refined in a case study. For the developed method to add value to the TCFD-guidelines seven key requirements on three different levels were identified. Firstly, on the applicational level, the method has to be engaging, generate a feeling of ownership and be applicable within time and resource constraints. Secondly, on the corporate level, the method has to generate decision useful information and be replicable and repeatable. And finally, on the supranational level, the method has to align with the goals of governing for financial stability and induce some form of transformative collective action. The developed method satisfies the requirements on the applicational level. On the corporate level it generates decision useful information, is flexible enough to be replicable, yet consistent enough to be repeatable. And finally, on the supranational level, the developed method aligns with the goals of governing for financial stability by successfully identifying direct climate-related risks and opportunities but is not yet

Difficult-to-treat asthma affects a minority of adults and children with asthma but represents a challenging mix of misdiagnosis, multimorbidity, inadequate self-management, severe airway pathobiology, and treatment complications. Management of these patients extends beyond asthma pharmacotherapy, because multiple other patient-related domains need to be addressed as well. Such complexity can hinder adequate clinical assessment even when performed in specialist practice. Systematic assessment undertaken by specialized multidisciplinary teams brings a broad range of resources to bear on patients with difficult-to-treat asthma. Although the concept of systematic assessment is not new, practices vary considerably and implementation is not universal. Nevertheless, assessment protocols are already in place in several institutions worldwide, and outcomes after such assessments have been highly encouraging. This review discusses the rationale, components, and benefits of systematic assessment, outlining its clinical utility and the available evidence for improved outcomes. It describes a range of service configurations and assessment approaches, drawing examples from severe asthma centers around the world to highlight common essential elements. It also provides a framework for establishing such services and discusses practical considerations for implementation.

Deskundigen nemen in het Verhaal van de Rijntakken de Waal (inclusief de Bovenrijn), de Nederrijn-Lek (inclusief het Pannerdensch Kanaal) en de IJssel kritisch onder de loep. Het verhaal gaat in op de vorming van deze Rijntakken inclusief hun relatie met het stroomgebied, en de opgaven en uitdagingen waar de betrokkenen bij beheer en inrichting van deze rivieren voor staan. Het verhaal is te beschouwen als een advies van deskundigen aan deze betrokkenen. De deskundigen geven een aantal richtinggevende gidsprincipes voor beleid, beheer en inrichting. Het verhaal levert daarmee een bijdrage aan de maatschappelijke discussie over de koers voor beheer en inrichting van de Rijn in Nederland.

Het rapport gaat in op de beheer en beleids van de grote rivieren in Nederland en beschrijft de rol die het onderzoek in Rivers2Morrow (een onderzoeksprogramma gefinancierd door RWS en DGWB, met universiteiten en Deltares als partners). Als bijlage zijn er 3 infographics toegevoegd, die (1) de Beleidsvragen en Onderzoeksopdrachten beschrijven, (2) Het systeem (interactie tussen sediment, sedimenttransport en morfologie) en (3) een overzicht van de beleidsvragen die beantwoord worden binnen Rivers2Morrow.

This report presents an inventory on current and planned research activities on sediment (and morpho-) dynamics of the Dutch part of the Rhine River system. Scientific research on sediment dynamics in the Rhine River system is being carried out at 4 universities (Delft University of Technology, Utrecht University, Wageningen University & Research and University of Twente), partly in collaboration with Deltares and Rijkswaterstaat. Rijkswaterstaat also carries out a number of pilot studies, and is responsible for monitoring and management of sediment dynamics and morphodynamics of the Dutch Rhine. These activities are also summarized in this report. In addition to current and planned activities, activities that should be carried out according to experts interviewed for this report but are missing so far have also been inventoried.

Het vertrekpunt van deze evaluatie is deel 4 van de Planologische Kernbeslissing (PKB) Ruimte voor de Rivier (vastgesteld in 2007). Dit ‘PKB deel 4’ beschrijft het beleid om uiterlijk in 2015 het vereiste veiligheidsniveau langs de Rijntakken en het benedenstroomse deel van de Maas te realiseren, evenals de daarmee samenhangende verbetering van de ruimtelijke kwaliteit. Het ‘vereiste veiligheidsniveau’ is de (toen geldende) wettelijke norm voor de waterkeringen langs de rivieren: de maatgevende hoogwaterstand met bijbehorende overschrijdingskans die de waterkeringen op zijn minst veilig moeten kunnen keren.