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ObjectiveA substantial part of non-traumatic intracerebral haemorrhages (ICH) arises from a macrovascular cause, but there is little guidance on selection of patients for additional diagnostic work-up. We aimed to develop and externally validate a model for predicting the probability of a macrovascular cause in patients with non-traumatic ICH.MethodsThe DIagnostic AngioGRAphy to find vascular Malformations (DIAGRAM) study (n=298; 69 macrovascular cause; 23%) is a prospective, multicentre study assessing yield and accuracy of CT angiography (CTA), MRI/ magnetic resonance angiography (MRA) and intra-arterial catheter angiography in diagnosing macrovascular causes in patients with non-traumatic ICH. We considered prespecified patient and ICH characteristics in multivariable logistic regression analyses as predictors for a macrovascular cause. We combined independent predictors in a model, which we validated in an external cohort of 173 patients with ICH (78 macrovascular cause, 45%).ResultsIndependent predictors were younger age, lobar or posterior fossa (vs deep) location of ICH, and absence of small vessel disease (SVD). A model that combined these predictors showed good performance in the development data (c-statistic 0.83; 95% CI 0.78 to 0.88) and moderate performance in external validation (c-statistic 0.66; 95% CI 0.58 to 0.74). When CTA results were added, the c-statistic was excellent (0.91; 95% CI 0.88 to 0.94) and good after external validation (0.88; 95% CI 0.83 to 0.94). Predicted probabilities varied from 1% in patients aged 51–70 years with deep ICH and SVD, to more than 50% in patients aged 18–50 years with lobar or posterior fossa ICH without SVD.ConclusionThe DIAGRAM scores help to predict the probability of a macrovascular cause in patients with non-traumatic ICH based on age, ICH location, SVD and CTA.

The aim of this study is to explore the possibilities to implement ‘Building with North Sea Nature’ in offshore infrastructures in the North Sea by providing guidelines for the eco-friendly design of scour protection structures around monopiles in planned wind farms to enhance ecological functioning.The guidelines include specifications on: The type of hard substrate material or products available and how these can potentially enhance ecological functioning (and have added value compared to regular types used); How different types of hard substrates and configurations can be (experimentally) designed to vary spatially, in such a systematic manner that the effect on ecological enhancement can be determined empirically; How the effects of these scour protection structures can be monitored and evaluated; Whether site-specific conditions apply to wind planned farm locations in the Dutch North Sea. Eco-friendly design in this study entails optimising the scour protection of offshore wind farms to enhance its ecological functioning. Enhancement of ecological functioning has been defined as: increasing habitat suitability for species (or communities) occurring naturally in the Dutch North Sea, in particular, for policyrelevant(from a conservation perspective) and endangered species, such as thoselisted in the EU Habitats Directive, OSPAR or national red lists (see Annex 2 in Bos et al. in prep.). Where previous work has explored the more general possibility for enhancement of ecological functioning in offshore wind farms (van Duren et al. 2016; Smaal et al. in prep.), this study provides explicit steps towards realising an eco-friendly design of scour protection and a practical field experiment to allow for scientific evaluation. From an analysis of physical conditions in the North Sea that influence both biodiversity and scouring mechanisms at wind farm locations, it is concluded that scour protection will be required in most, or all, future offshore wind farms on the Dutch Continental Shelf. It is also concluded that scour protection design could be altered to benefit the ecology, but that new designs will require additional testing foranti-scouring effects. Based on a selection of policy-relevant species for the North Sea, two umbrella species were selected: Atlantic cod (Gadus morhua) and European flat oyster (Ostrea edulis). Focussing design variables and principles on these two umbrella species is expected to result in optimising the habitat for a wide range of native hard substrate biodiversity. Based on existing data from current wind farm scour protection, other artificial hard substrates and natural hard substrates from the North Sea, it is hypothesized that an optimised design of scour protection will yield increased populations of umbrella species or increased native biodiversity in general, including policy-relevant species.Based on available knowledge on ecological principles and expert judgement of North Sea hard substrate ecologists, four design variables for optimised scour protection are defined: 1. Adding larger structures than conventional scour protection to create large holes and crevices, to provide adequate shelter / holes for large mobile species. 2. Adding more small-scale structures than conventional scour protection to create more small-scale holes and crevices but also attachment substrate and settlement substrate. 3. Providing or mimicking natural (biogenic) chemical substrate properties to facilitate species. An example is to provide chalk-rich substrate such as concrete with added chalk, or even natural substrate such as shell material. 4. Active introduction of specimens of target species to enhance establishment of new populations. This is to facilitate recruitment at locations where reproduction by naturally occurring adults is These design variables are made practically applicable by providing examplematerials and specifications for implementation in the field and, a cost overview is provided for example materials. Combining the above information, this study provides design guidelines for wind farms with optimised scour protection to enhance ecological functioning. In addition it defines a minimum and a standardized approach for deployment and monitoring of a subset of locations to allow for scientific evaluation. The monitoring techniques that are required to do so, are described and a cost estimate for the monitoring is provided.In conclusion, this study provides eco-friendly design principles for scour protection and a first experimental design to implement ‘Building with North Sea Nature’: ecological enhancement by optimising scour protection in offshore wind farms. This is considered as a first step in a process that should result in ‘learning by doing’.

Verslag van de editie 2009 van het congres gezondheidsmanagement ‘Bedrijf in Beweging’. Deze bevatte 39 parallelsessies in de vorm van (interactieve) lezingen, workshops en rondetafelsessies. Die raakten allemaal aan de thema’s ‘diversiteit’ en ‘gezond management en de huidige economische situatie’, maar liepen ook uiteen in vorm en inhoud. Dit verslag geeft een beeld van de diversiteit én de rode draad van het congres. Per sessie is er een korte samenvatting

Samenvatting van het congres Gezondheidsmanagement Bedrijf in Beweging. Met per sessie een kort verslag. Hoe zorgt de werkgever ervoor dat de medewerkers gezond blijven en hun werk goed kunnen blijven doen? En wat kunnen medewerkers hier zelf aan doen? Welke rol spelen bevlogenheid, werkplezier, motivatie en zingeving voor werkenden daarin?

Verslag van de discussies, lezingen en presentaties gehouden tijdens het congres Gezondheidsmanagement, Bedrijf in Beweging, over gezondheidsbeleid op het werk

Verslag van het eerste themacongres gezondheidsmanagement, dinsdag 7 maart 2006. In deze publicatie wordt teruggekeken op de conferentie, passeren de inleidingen de revue en worden de workshops verslagen. Tijdens de conferentie toonden de initiatiefnemers een aantal voorbeelden van organisaties waar gezondheid goed gemanaged wordt. Ook de manier waarop een organisatie tot gezondheidsmanagement kan komen, kwam uitgebreid aan de orde, waarbij een duidelijke koppeling gemaakt wordt naar de WIA en Levensloopregeling

Deze TNO publicatie bevat een methodiekbeschrijving die een leidraad vormt en een hulpmiddel is voor het ontwikkelen, implementeren en uitbouwen van Integraal GezondheidsManagement (IGM) in de organisatie. IGM is het systematisch managen van de bedrijfsactiviteiten met het doel de gezondheid van mens en bedrijf te bevorderen. De methodiek van IGM is gebaseerd op zeven ontwikkelingslijnen: -Gezondheid als strategisch thema. -Een gezond primair proces. -Een gezonde fysieke (werk)omgeving. -Een gezonde sociale (werk)omgeving. -Gezonde mensen. -Een gezonde relatie met de directe leefomgeving. -Gezonde producten en/of diensten. De ontwikkelingslijnen en verdere opzet van de methodiek worden eerst beknopt toegelicht in de tweede paragraaf en daarna, in paragraaf 3, uitgewerkt in de zogenaamde IGM Meter. Deze vormt, als analyse- en verbeteringsinstrument een kernelement van de methodiek. Dit wordt gevolgd door een handleiding voor de stapsgewijze implementatie van IGM in de organisatie en voor het voortbouwen op het concept daarna. In paragraaf 3 vindt men ook allerlei hulpmiddelen voor het implementatieproces. De huidige versie van de methodiek is gebaseerd op literatuuronderzoek, ervaringen van onderzoekers/adviseurs en de praktijk van voorbeeldbedrijven. Deze methodiek zal de komende periode via pilotprojecten op onderdelen verder worden uitgewerkt en worden verrijkt met praktijkvoorbeelden, extra instrumentarium, hints en tips.

Background Patients suffering from intracerebral haemorrhage have a poor prognosis, especially if they are using antiplatelet therapy. Currently, no effective acute treatment option for intracerebral haemorrhage exists. Limiting the early growth of intracerebral haemorrhage volume which continues the first hours after admission seems a promising strategy. Because intracerebral haemorrhage patients who are on antiplatelet therapy have been shown to be particularly at risk of early haematoma growth, platelet transfusion may have a beneficial effect. Methods/Design The primary objective is to investigate whether platelet transfusion improves outcome in intracerebral haemorrhage patients who are on antiplatelet treatment. The PATCH study is a prospective, randomised, multi-centre study with open treatment and blind endpoint evaluation. Patients will be randomised to receive platelet transfusion within six hours or standard care. The primary endpoint is functional health after three months. The main secondary endpoints are safety of platelet transfusion and the occurrence of haematoma growth. To detect an absolute poor outcome reduction of 20%, a total of 190 patients will be included. Discussion To our knowledge this is the first randomised controlled trial of platelet transfusion for an acute haemorrhagic disease. Trial registration The Netherlands National Trial Register (NTR1303)

The aim of this paper is to optimize power cable routing in a wind farm based on the expected morphological behaviour in the design lifetime of an offshore wind farm. Up to now methods to optimize cable route layout in offshore wind farms are only based on a flat seabed and do not take the seabed dynamics into account. For offshore wind farms, migrating seabed features in the form of sand waves are of great importance and may significantly alter the position of the seabed over the life time of the wind farm. This paper discusses the optimization of power cable routing in a morphodynamic seabed by assessing the power cable burial depth in both the vertical plane, e.g. buried deeper in areas where future seabed lowering is expected, and in the horizontal plane, e.g. diverting the power cables around risk prone areas. Outcomes of the proposed method showed both cost and risk reductions for the Hollandse Kust (zuid) Wind Farm case study compared to state-of-the-art optimization based on a fixed burial depth