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Background Patients with stage 4/5 chronic kidney disease (CKD) suffer from various symptoms. The retention of uremic solutes is thought to be associated with those symptoms. However, there are relatively few rigorous studies on the potential links between uremic toxins and symptoms in patients with CKD. Methods The EQUAL study is an ongoing observational cohort study of non-dialyzed patients with stage 4/5 CKD. EQUAL patients from Germany, Poland, Sweden and the UK were included in the present study (n = 795). Data and symptom self-report questionnaires were collected between April 2012 and September 2020. Baseline uric acid and parathyroid hormone and 10 uremic toxins were quantified. We tested the association between uremic toxins and symptoms and adjusted P-values for multiple testing. Results Symptoms were more frequent in women than in men with stage 4/5 CKD, while levels of various uremic toxins were higher in men. Only trimethylamine N-oxide (TMAO; positive association with fatigue), p-cresyl sulfate (PCS) with constipation and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (negative association with shortness of breath) demonstrated moderately strong associations with symptoms in adjusted analyses. The association of phenylacetylglutamine with shortness of breath was consistent in both sexes, although it only reached statistical significance in the full population. In contrast, TMAO (fatigue) and PCS and phenylacetylglutamine (constipation) were only associated with symptoms in men, who presented higher serum levels than women. Conclusion Only a limited number of toxins were associated with symptoms in persons with stage 4/5 CKD. Other uremic toxins, uremia-related factors or psychosocial factors not yet explored might contribute to symptom burden.

Additional file 1.

Clinical epidemiological studies often focus on investigating the underlying causes of disease. For instance, a nephrologist may be interested in the association between blood pressure and the development of chronic kidney disease (CKD). However, instead of focusing on the mere occurrence of CKD, the decline of kidney function over time might be the outcome of interest. For examining this kidney function trajectory, patients are typically followed over time with their kidney function estimated at several time points. During follow-up, some patients may drop out earlier than others and for different reasons. Furthermore, some patients may have greater kidney function at study entry or faster kidney function decline than others. Also, a substantial heterogeneity may exist in the number of kidney function estimates available for each patient. This heterogeneity with respect to kidney function, dropout and number of kidney function estimates is important to take into account when estimating kidney function trajectories. In general, two methods are used in the literature to estimate kidney function trajectories over time: linear regression to estimate individual slopes and the linear mixed-effects model (LMM), i.e. repeated measures analysis. Importantly, the linear regression method does not properly take into account the above-mentioned heterogeneity, whereas the LMM is able to retain all information and variability in the data. However, the underlying concepts, use and interpretation of LMMs are not always straightforward. Therefore we illustrate this using a clinical example and offer a framework of how to model and interpret the LMM.

The HIV Research for Prevention (HIVR4P) conference is dedicated to advancing HIV prevention research, responding to a growing consensus that effective and durable prevention will require a combination of approaches as well as unprecedented collaboration among scientists, practitioners, and community workers from different fields and geographic areas. The conference theme in 2018, "From Research to Impact," acknowledged an increasing focus on translation of promising research findings into practical, accessible, and affordable HIV prevention options for those who need them worldwide. HIVR4P 2018 was held in Madrid, Spain, on 21-25 October, with >1,400 participants from 52 countries around the globe, representing all aspects of HIV prevention research and implementation. The program included 137 oral and 610 poster presentations. This article presents a brief summary of highlights from the conference. More detailed information, complete abstracts as well as webcasts and daily Rapporteur summaries may be found on the conference website.

Om mbo-studenten die willen doorstromen naar het hbo beter voor te bereiden op het hbo, bieden veel roc’s in samenwerking met hogescholen het Keuzedeel Voorbereiding hbo aan. In dit onderzoek zijn de eerste ervaringen en opbrengsten van het Keuzedeel onderzocht. Hiervoor zijn betrokken ontwikkelaars en uitvoerders geïnterviewd en zijn de ervaringen en leerontwikkeling van deelnemers gemeten aan de hand van een survey. Het onderzoek is tot stand gekomen in samenwerking met de onderwijsinstellingen die zijn vertegenwoordigd in het Regionaal Netwerk mbo-hbo Noord-Holland – Flevoland.

Charitable organizations send out large volumes of direct mailings, soliciting for money in support of many good causes. Without any request, donations are rarely made, and it is well known that each request for money by a charity likely generates at least some revenues. Whether a single request from a charity increases the total amount donated by an individual is however unknown. Indeed, a response to one request can hurt responses to others. The net effect is therefore not easily observable, certainly not when multiple charities address the same individuals. In this paper we alleviate these observational difficulties by carrying out a field experiment in which five large charities cooperate. With the unique data that we collect, we study the impact of sending more requests on total donations. The results indicate that there is a negative competitive effect on requests from other charities, but this effect dies out rapidly. Soon after the mailing has been sent, it is only a strong cannibalization of the charity’s own revenues that prevails. This empirical finding suggests the important conclusion that not much coordination across charities is needed to increase revenues. We also demonstrate that charities need sophisticated evaluation tools that do not ignore the effects of cannibalization.

Charities mainly rely on direct mailings to attract the attention of potential donators. Individuals may feel irritated by these mailings, in particular when they receive many mailings. We study the consequences of perceived irritation on stated behavior and on actual behavior. Target selection by charities likely results in good donators receiving many mailings and hence they might also be most irritated. Therefore, irritation with direct mailings might be endogenously determined. To create exogenous variation in irritation, we design a unique controlled field experiment in cooperation with five of the largest charities in the Netherlands. Our analysis reveals that direct mailings do result in irritation, but surprisingly this affects neither stated nor actual donating behavior.

Stigas, Wageningen UR (WUR) en PPO Bloembollen zochten naar geschikte oplossingen om een groot deel van het zware werk uit handen te kunnen nemen door bij de ontwikkeling van een uniforme fust voor de bloembollensector rekening te houden met de ergonomische aanbevelingen kan ook het resterende handwerk gemakkelijker gemaakt worden

In 2006 a study is done to generate ergonomic advices with respect to the design of a standardized crate that is to be used in flower bulb cultivation and flower bulb trade. Reason for this study was an earlier AKK study, which concluded that standardisation of the crates will reduce costs (particularly for transport) and improve flower bulb quality. Therefore, companies in this sector try to implement standardized crates.The aim of the present study was to give ergonomic advices concerning the layout of these crates, resulting in reduction of the physical load during manual handling of them. Another goal was to satisfy the people who will have to work with the crates, by respecting their wishes and requirements as far as possible.In close cooperation with the manager of the AKK-study, labour-related questions which remained unanswered in that study are inventoried. Further, according to the method `ergonomic design, additional wishes of the people who will have will work with the standardised crates have been formulated. Finally is examined how the inventoried requirements and wishes can be fulfilled. For that purpose the questions were answered, based on literature reviews, measurements and expertise.Some of the most important results are that:Physical load is lower during the lifting of 40x60 cm crates than during the lifting of 50x75 cm crates with the same weight.The physical load during the lifting of low standing crates reduces when the crates (and therefore handles) are as high as possible, but this effect is very small. Since the height of the piles is limited by other factors, no effect of crate altitude on physical load is expected when crates have to be moved from or to a high level. Without the use of special tools the physical load is always too high when piles are higher than 1.70 m. But even in ideal conditions the lifting of 15 or 20 kg crates to an altitude of 1.70 m results in a Lifting Index of 1.1 or 1.4 respectively, what is higher than the health standard.For handles, a dimension of 125x40 mm is recommended. Sharp edges must be avoided and it must be impossible to put sharp objects, such as staples, through the handles.Closed handles prevent that bulbs fall through the handles. Physical load when crates are taken from or placed on a high pile can be reduced al little when these handles are not only at the top of the crates, but also halfway.No large effect of standardisation of the layout of the crates on mechanisation is expected, since nearly all tools do not pick up the crates but grip them. Standardisation of the format (40x60 cm) is important, however, and the sides must be exactly rectangular.For transport in conditioned sea containers (inner width 2.26 or 2.28 m.) 100x120 cm pallets are most suitable. However, physical load during manual piling up of crates on these pallets is higher than when 80x100 cm pallets are used. In both cases the health limits are largely exceeded during manual handling of the crates.If crates with different altitudes must become piled up on the same pallet, tuning of the altitude of the different crates is needed. Good examples are 18 and 24 cm or 16.5 and 22 cm. If it must be possible to read the information on the crates automatically, transponders (chips) are preferred over bar codes. It is recommended to apply a low-frequency system and to give all crates only a unique number. A central database can contain information concerning the contents of all crates.The recommendations in this report answer different questions and some of them can not be combined with some others. For this reason the `ideal crate will be a combination of compromises. Therefore it is recommended - in accordance with the original design of this study to carry out a pilot before choosing definitively for one basic design for the standardized crates. In this pilot all users should be involved, and it is preferred to let them test a number of copies of the aimed types of cask. Voor de bloembollensector is het financieel aantrekkelijk over te schakelen naar uniformer fust. Op basis van ergonomische eisen en wensen aan dit fust zijn concrete aanbevelingen gedaan om bij de ontwikkeling of keuze van het geüniformeerde fust ook rekening te houden met de werkenden

Direct mailing is the main tool that charities employ for fundraising. With increasing amounts of soliciting mailings and with the best donators receiving more mailings as a result of target selection, irritation might increase. As a result, such irritation could cause individuals to donate less, and hence reduce revenues for charities. We develop a conceptual model, which relates donating behavior to irritation and to mailing frequencies. We consider mailing frequencies relative to a reference point, which we call the maximum acceptance level. Furthermore, we allow for asymmetric effects of positive and negative differences with this maximum acceptance level, and hence we consider the effects of receiving excessive and acceptable amounts of mailings. To test our model empirically, we conduct a survey on charitable direct mailings and donating behavior among 213 respondents. We find that too many mailings do indeed lead to irritation, and that such irritation reduces annual donations.

Een inventarisatie is gemaakt van hulpmiddelen die de fysieke belasting als gevolg van fusthandling in de bloembollen- en bolbloementeelt kan verminderen. Op praktijkbedrijven zijn de invloed op de fysieke belasting en de inzetbaarheid op verschillende plaatsen in het productieproces beoordeeld. Ook zijn jaarkosten berekend en te verwachten arbeidsbesparingen bepaald