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Abstract Background Outpatient Clinics (OCs) are under pressure because of increasing patient volumes and provider shortages. At the same time, many patients with chronic diseases receive routine follow-up consultations that are not always necessary. These patients block access to care for patients that are in actual need for care. Pre-assessing patient charts has shown to reduce unnecessary outpatient visits. However, the resulting late cancellations due to the pre-assessment, challenge efficient alignment of capacity with actual patient demand, leading to either empty slots or overtime. This study aims to develop a method to analyse the effect of pre-assessing patients before inviting them to the OC. This involves 1) to select who should come and 2) to optimize the impact of pre-assessment on the schedule and efficient use of OC staff. Methods This prospective mixed-methods evaluation study consists of 1) an expert meeting to determine a pre-assessment strategy; 2) a retrospective cohort study to review the impact of this strategy (12 months of a Dutch nephrology OC); 3) mathematical optimization to develop an optimal criteria-based scheduling strategy; and 4) a computer simulation to evaluate the developed strategy. Primary outcomes are the staff idle time and staff overtime. Secondary outcomes evaluate the number of weekly offered appointments. Results The expert group reached consensus about the pre-assessment criteria. 875 (18%) of the realized appointments in 2022 did not meet the OC visit pre-assessment criteria. In the best performing scheduling strategy, 94 slots (87% of the available capacity) should be scheduled on a weekly basis. For this schedule, 26.8% of the OC weeks will experience idle time ( $$\mu$$ μ =2.51, $$\sigma$$ σ =1.44 appointment slots), and 21% of the OC weeks will experience overtime ( $$\mu$$ μ =2.26, $$\sigma$$ σ =1.65 appointment slots) due to the variation in patient appointment requests. Using the pre-assessment strategy combined with the best performing scheduling strategy under full capacity (108 slots), up to 20% increase in patient demand can be handled with equal operational performance. Conclusions This evaluation study allows OC managers to virtually test operational impact of pre-assessment strategies on the capacity of their OC, and shows the potential of increasing efficient use of scarce healthcare capacity. Trial registration Not applicable.

Additively manufactured Nitinol (NiTi) architectured materials, designed with unit cell architectures, hold promise for customisable applications. However, the common assumption of homogeneity in modeling and additive manufacturing of these architectured materials needs further investigation because geometric-dependent melt pool behaviour results in inhomogeneous microstructure and thermomechanical properties. This study shows that property inhomogeneity at the mesoscale is one reason for pseudo-linear response and partial superelasticity of the fabricated NiTi body-centered cubic (BCC) architectured materials. We modeled using a phenomenological constitutive relation and additively manufactured NiTi architectured materials with varying relative densities. These fabricated samples showed distinct microstructural textures and compositions that affected their local recoverability. The edge effects and laser turn regions were identified as the causes underlying the observed microstructural inhomogeneity. The dimensionless Fourier number is used to describe the transition of printing modes. This study provides valuable information on rigorous experimental/computational consistency in future work.

Superelastic metallic materials possessing large recoverable strains are widely used in automotive, aerospace and energy conversion industries. Superelastic materials working at high temperatures and with a wide temperature range are increasingly required for demanding applications. Until recently, high-temperature superelasticity has only been achievable with multicomponent alloys fabricated by complex processes. In this study, a novel framework of multi-scale models enabling texture and microstructure design is proposed for high-performance NiTi fabrication via laser powder bed fusion. Based on the developed framework, a Ni-lean Ni(49.4 at.%)-Ti alloy is, for the first time, endowed with a 4% high-temperature compressive superelasticity. A 001 texture, unfavorable for plastic slip, is created to realize enhanced functionality. The unprecedented superelasticity can be maintained up to 453 K, which is comparable with but has a wider superelastic temperature range (∼110 K) than rare earth alloyed NiTi alloys, previously only realizable with grain refinement, and other complicated post-processing operations. At the same time, its shape memory stability is also improved due to existing textured 100 martensite and intergranular precipitation of Ti2NiOx. This discovery reframes the way that we design superior performance NiTi based alloys through directly tailoring crystallographic orientations during additive manufacturing.

Introduction Both rituximab (RTX) and cyclophosphamide (CYC) are effectively used in combination with steroids as remission induction therapy for patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Several studies have shown that the effect on achieving (clinical) remission, frequency and severity of relapses is equivalent for both therapies, but there is accumulating data that the long-term safety profile of RTX might outperform CYC. Combination of RTX with low-dose CYC (LD-CYC) has been investigated in only a few uncontrolled cohort studies, in which clinical remission and a favourable immunological state with low relapse rates was quickly achieved. In this randomised controlled trial, we aim to investigate whether the combination treatment (RTX+LD CYC) is superior in comparison to standard care with RTX only.Methods and analysis This study is an open-label, multicentre, 1:1 randomised, prospective study for patients with AAV with generalised disease, defined as involvement of major organs, that is, kidneys, lungs, heart and nervous system. In total, 100 patients will be randomised 1:1 to receive either remission induction therapy with standard of care (RTX) or combination treatment (RTX+LD CYC) in addition to steroids and both arms are followed by maintenance with RTX retreatments (tailored to B-cell and ANCA status). Our primary outcome is the number of retreatments needed to maintain clinical remission over 2 years. Secondary outcomes are relevant clinical endpoints, safety, quality of life and immunological responses.Ethics and dissemination This study has received approval of the Medical Ethics Committee of the Leiden University Medical Center (P18.216, NL67515.058.18, date: 7 March 2019). The results of this trial (positive and negative) will be submitted for publication in relevant peer-reviewed publications and the key findings presented at national and international conferences.Trial registration number NCT03942887.

In this work, the hydrogen fatigue of pipeline steel X60, its girth welds and weld defects were investigated through in situ fatigue testing. A novel in situ gaseous hydrogen charging fatigue set-up was developed, which involves a sample geometry that mimics a small-scale pipeline with high internal hydrogen gas pressure. The effect of hydrogen was investigated by measuring the crack initiation and growth, using a direct current potential drop (DCPD) set-up, which probes the outer surface of the specimen. The base and weld metal specimens both experienced a reduction in fatigue life in the presence of hydrogen. For the base metal, the reduction in fatigue life manifested solely in the crack growth phase; hydrogen accelerated the crack growth by a factor of 4. The crack growth rate for the weld metal accelerated by a factor of 8. However, in contrast to the base metal, the weld metal also experienced a reduction of 57% in resistance to crack initiation. Macropores (>500 µm in size) on the notch surface reduced the fatigue life by a factor of 11. Varying the pressure from 70 barg to 150 barg of hydrogen caused no difference in the hydrogen fatigue behavior of the weld metal. The fracture path of the base and weld metal transitioned from transgranular and ductile in nature to a mixed-mode transgranular and intergranular quasi-cleavage fracture. Hydrogen accelerated the crack growth by decreasing the roughness- and plasticity-induced crack closure. The worst case scenario for pipelines was found in the case of weld defects. This work therefore highlights the necessity to re-evaluate pipelines for existing defects before they can be reused for hydrogen transport.

This study investigated the in-situ gaseous (under 150 bar) hydrogen embrittlement behaviour of additively manufactured (AM) Inconel 718 produced from sustainable feedstock. Here, sustainable feedstock refers to the Inconel 718 powder produced by vacuum induction melting inert gas atomisation of failed printed parts or waste from CNC machining. All Inconel 718 samples, namely AM-as-processed, AM-heat-treated and conventional samples showed severe hydrogen embrittlement. Additionally, it was found that despite its higher yield strength (1462 ± 8 MPa) and the presence of δ phase, heat-treated AM Inconel 718 demonstrates 64% lower degree of hydrogen embrittlement compared to the wrought counterpart (Y.S. 1069 ± 4 MPa). This was linked to the anisotropic microstructure induced by the AM process, which was found to cause directional embrittlement unlike the wrought samples showing isotropic embrittlement. In conclusion, this study shows that AM Inconel 718 produced from recycled feedstock shows better hydrogen embrittlement resistance compared to the wrought sample. Furthermore, the unique anisotropic properties, seen in this study for Inconel 718 manufactured by laser powder bed fusion, could be considered further in component design to help minimise the degree of hydrogen embrittlement.

Using high-resolution spectra of Ni ii recorded using Fourier transform (FT) spectroscopy of continuous, nickel–helium hollow cathode discharge sources in the region 143–5555 nm (1800–70,000 cm ^−1 , the analysis of 1016 Ni ii lines confirmed and optimized 206 previously reported energy levels of the ( ^3 F ) parent term, from 3 d ^8 ( ^3 F )5 f to 3 d ^8 ( ^3 F )9 s , lying between 122,060 and 138,563 cm ^−1 . The uncertainties of these levels have been improved by at least an order of magnitude compared with their previously reported values. With the increased resolution and spectral range of the FT measurements, compared to previously published grating spectra, we were able to extend our analysis to identify and establish 33 new energy levels of Ni ii , which are reported here for the first time. Eigenvector compositions of all revised and newly established energy levels were calculated using the orthogonal operator method. In addition, an improved ionization energy of 146,541.35 ± 0.15 cm ^−1 for Ni ii , using highly excited levels of the 3 d ^8 ( ^3 F )5 g , 3 d ^8 ( ^3 F )6 g , and 3 d ^8 ( ^3 F )6 h configurations, has been derived.

Dutch Resolution is the term given to the use of mixtures (families) of resolving agents in classical resolutions. In this status report an overview is given of the latest results and new (possible) families of resolving agents are introduced. The concept of families is discussed as well as the factors that come into play on use of families. Practical aspects of Dutch Resolution in particular and resolutions in general are discussed. [ABSTRACT FROM AUTHOR]

To date, the treatment of immune-mediated kidney diseases has only marginally benefited from highly specific biological drugs that have demonstrated remarkable effects in many other diseases. What accounts for this disparity? In April 2016, the International Society of Nephrology held a Nexus meeting on Translational Immunology in Nephrology in Berlin, Germany, to identify and discuss hurdles that block the translational flow of target identification, and preclinical and clinical target validation in the domain of immune-mediated kidney disease. A broad panel of experts including basic scientists, translational researchers, clinical trialists, pharmaceutical industry drug developers, and representatives of the American and European regulatory authorities made recommendations on how to overcome such hurdles at all levels of the translational research process. The results of these discussions are presented here, which may serve as a roadmap for how to optimize the process of developing more innovative and effective drugs for patients with immune-mediated kidney diseases.

Multinodular goitre is the most common thyroid gland disorder. It can cause hyperthyroidism and mechanical complaints such as tracheal compression or dysphagia. We report a unique case of a patient with a toxic multinodular goitre presenting with a deep venous thrombosis of the left arm due to direct local compression of blood flow.

Nitric oxide (NO) has been implicated in matrix metallopeptidase 9 (MMP9)-dependent mobilization of hematopoietic stem and progenitor cells from bone marrow (BM). However, direct measurement of NO in the BM remained elusive due to its low in situ concentration and short lifetime. Using NO spin trapping and electron paramagnetic resonance (EPR) spectroscopy we give the first experimental confirmation of free NO radicals in rodent BM. NO production was quantified and attributed to enzymatic activity of NO synthases (NOS). Although endothelial NOS (eNOS) accounts for most (66%) of basal NO, we identified a significant contribution (23%) from inducible NOS (iNOS). Basal NO levels closely correlate with MMP9 bioavailability in BM of both hypertensive and control rats. Our observations support the hypothesis that inadequate mobilization of BM-derived stem and progenitor cells in hypertension results from impaired NOS/NO/MMP9 signalling in BM, a condition that may be corrected with pharmacological intervention.

Lead contaminated soil is a persistent global threat to the health of animal populations. Nevertheless, links between soil lead and its adverse effects on exposed wildlife remain poorly understood. Here, we explore local geographic patterns of exposure in urban birds along a gradient of lead contamination in Broken Hill, an Australian mining city. Soil lead concentrations are linked to co-located blood lead measurements in rock pigeons (Columba livia), house sparrows (Passer domesticus), crested pigeons (Ocyphaps lophotes) and white-plumed honeyeaters (Lichenostomus ornatus). Median blood lead levels were highest in crested pigeons (59.6 μg/dL), followed by house sparrows (35.2 μg/dL), rock pigeons (35.1 μg/dL), and white-plumed honeyeaters (27.4 μg/dL). Blood lead levels in all species declined away from mining areas, the primary source of lead contamination in Broken Hill. Blood lead increased significantly and at the greatest rate relative to soil lead in the three ground foraging species (crested pigeons, house sparrows, rock pigeons). For these species, soil lead concentrations below 200 mg/kg and 900 mg/kg were needed to maintain a median blood lead concentration under the lower threshold of the subtoxic (20-50 μg/dL) and toxic (≥50 μg/dL) effect ranges previously identified for some bird species. We also investigated the effects of lead exposure on blood haemoglobin levels as a general measure of physiological condition in birds exposed to different levels of soil lead contamination. Overall, for every 1 μg/dL increase in blood lead, haemoglobin decreased by 0.11 g/L. The rate of this decrease was not significantly different between species, which supports the measurement of haemoglobin as a consistent though insensitive measure of physiological condition in chronically lead exposed birds. Our findings reflect the importance of lead contaminated soil as a widespread source of elevated blood lead and supressed haemoglobin levels in birds inhabiting urbanised and mining impacted environments., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Simon C Griffith reports financial support was provided by Australian Research Council. Simon C Griffith reports financial support was provided by New South Wales Department of Primary Industries. Mark Patrick Taylor reports a relationship with New South Wales Environmental Protection Authority that includes: consulting or advisory and funding grants. Mark Patrick Taylor reports a relationship with Broken Hill Environmental Lead Program that includes: consulting or advisory and funding grants. Mark Patrick Taylor reports a relationship with Australian Federal Government that includes: consulting or advisory and funding grants. Mark Patrick Taylor reports a relationship with Australian Building Codes Board that includes: consulting or advisory and funding grants. Mark Patrick Taylor reports a relationship with Environmental Protection Authority Victoria that includes: employment. Mark Patrick Taylor has undertaken work for, and received funding from, the Broken Hill Environmental Lead Program of the New South Wales Environment Protection Authority (EPA). He has received funding for lead and other trace metal related work from the Australian Federal Government. He has also prepared commissioned reports and provided expert advice on environmental contamination and human health for a range of bodies, including the Australian Building Codes Board (lead in plumbing fittings and materials), lawyers, governments, union agencies, and private companies. He has also served as an expert in plaintiff cases of childhood lead poisoning relating to Mount Isa, Queensland and Kabwe, Zambia. No other authors declare a competing interest. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Our understanding of connections between human and animal health has advanced substantially since the canary was introduced as a sentinel of toxic conditions in coal mines. Nonetheless, the development of wildlife sentinels for monitoring human exposure to toxins has been limited. Here, we capitalized on a three-decade long child blood lead monitoring program to demonstrate that the globally ubiquitous and human commensal house sparrow ( Passer domesticus ) can be used as a sentinel of human health risks in urban environments impacted by lead mining. We showed that sparrows are a viable proxy for the measurement of blood lead levels in children at a neighborhood scale (0.28 km 2 ). In support of the generalizability of this approach, the blood lead relationship established in our focal mining city enabled us to accurately predict elevated blood lead levels in children from another mining city using only sparrows from the second location. Using lead concentrations and lead isotopic compositions from environmental and biological matrices, we identified shared sources and pathways of lead exposure in sparrows and children, with strong links to contamination from local mining emissions. Our findings showed how human commensal species can be used to identify and predict human health risks over time and space.

Heat waves are predicted to be detrimental for organismal physiology with costs for survival that could be reflected in markers of biological state such as telomeres. Changes in early life telomere dynamics driven by thermal stress are of particular interest during the early post-natal stages of altricial birds because nestlings quickly shift from being ectothermic to endothermic after hatching. Telomeres of ectothermic and endothermic organisms respond differently to environmental temperature, but few investigations within species that transition from ectothermy to endothermy are available. Also, ambient temperature influences parental brooding behaviour, which will alter the temperature experienced by offspring and thereby, potentially, their telomeres. We exposed zebra finch nestlings to experimental heat waves and compared their telomere dynamics to that of a control group at 5, 12 and 80 days of age that encapsulate the transition from the ectothermic to the endothermic thermoregulatory stage; we also recorded parental brooding, offspring sex, mass, growth rates, brood size and hatch order. Nestling mass showed an inverse relationship with telomere length, and nestlings exposed to heat waves showed lower telomere attrition during their first 12 days of life (ectothermic stage) compared to controls. Additionally, parents of heated broods reduced the time they spent brooding offspring (at 5 days old) compared to controls. Our results indicate that the effect of heat waves on telomere dynamics likely varies depending on age and thermoregulatory stage of the offspring in combination with parental brooding behaviour during growth., (© 2023 The Authors. Molecular Ecology published by John Wiley & Sons Ltd.)

Birds that breed opportunistically maintain partial activation of reproductive systems to rapidly exploit environmental conditions when they become suitable for breeding. Maintaining reproductive systems outside of a breeding context is costly. For males, these costs are thought to include continual exposure to testosterone. Males of seasonally breeding birds minimise these costs by downregulating testosterone production outside of a breeding context. Opportunistically breeding birds trade off the need to rapidly initiate reproduction with the costs of elevated testosterone production. One way opportunistically breeding males could minimise these costs is through fine scale changes in testosterone production across discrete reproductive stages which have a greater or lesser requirement for active sperm production. Although spermatogenesis broadly depends on testosterone production, whether changes in testosterone levels across the reproductive stages affect sperm quality and production is unknown. Here, we measured testosterone, sperm quality, and body condition in male zebra finches at discrete stages within reproductive bouts (egg laying, incubation, nestling provisioning, and fledging) and across two consecutive reproductive events in captive male zebra finches (Taeniopygia castanotis). We also examined associations between male testosterone, sperm quality/production, body condition, and nestling body condition. We found that testosterone levels varied across discrete reproductive stages with the lowest levels during incubation and the highest following chick fledging. Testosterone levels were positively associated with sperm velocity and the proportion of motile sperm but were not associated with male body condition. We found no associations between paternal body condition, testosterone levels, or sperm traits with nestling body condition (a proxy for the reproductive quality of a male and his partner). This study is the first to show that opportunistically breeding males vary testosterone synthesis and sperm traits at discrete stages within a reproductive event., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Understanding the consequences of heat exposure on mitochondrial function is crucial as mitochondria lie at the core of metabolic processes, also affecting population dynamics. In adults, mitochondrial metabolism varies with temperature but can also depend on thermal conditions experienced during development. We exposed zebra finches to two alternative heat treatments during early development: "constant", maintained birds at ambient 35 °C from parental pair formation to fledglings' independence, while "periodic" heated broods at 40 °C, 6 h daily at nestling stage. Two years later, we acclimated birds from both experiments at 25 °C for 21 days, before exposing them to artificial heat (40 °C, 5 h daily for 10 days). After both conditions, we measured red blood cells' mitochondrial metabolism using a high-resolution respirometer. We found significantly decreased mitochondrial metabolism for Routine, Oxidative Phosphorylation (OxPhos) and Electron Transport System maximum capacity (ETS) after the heat treatments. In addition, the birds exposed to "constant" heat in early life showed lower oxygen consumption at the Proton Leak (Leak) stage after the heat treatment as adults. Females showed higher mitochondrial respiration for Routine, ETS and Leak independent of the treatments, while this pattern was reversed for OxPhos coupling efficiency (OxCE). Our results show that short-term acclimation involved reduced mitochondrial respiration, and that the reaction of adult birds to heat depends on the intensity, pattern and duration of temperature conditions experienced at early-life stages. Our study provides insight into the complexity underlying variation in mitochondrial metabolism and raises questions on the adaptive value of long-lasting physiological adjustments triggered by the early-life thermal environment., (© 2023. The Author(s).)