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Obesity is considered a risk factor for surgical site infection (SSI). We quantified impact of body mass index (BMI) on the risk of SSI for a variety of surgical procedures.
We included 2012–2017 data from the Dutch national surveillance network PREZIES on a selection of frequently performed surgical procedures across different specialties. Patients were stratified into 5 categories: underweight (BMI, <18.5 kg/m2), normal weight (BMI, 18.5–25), overweight (BMI, 25–30), obese (BMI, 30–40) and morbidly obese (BMI, ≥40). Multilevel log binomial regression analyses were performed to assess the effect of BMI category on the risk of superficial, deep (including organ-space) and total SSI.
Of the 387,919 included patients (ranging from 2,616 for laparoscopic appendectomy to 119,834 for total hip prosthesis), 3,676 (1%) were underweight, 116,778 (30%) had normal weight, 154,339 (40%) were overweight, 104,288 (27%) had obesity, and 8,838 (2%) were morbidly obese. A trend of increasing risk of SSI when BMI increased from normal to morbidly obese was observed for almost all surgery types. The increase was most profound in surgeries with clean wounds, with relative risks for morbidly obese patients ranging up to 7.8 (95% CI, 6.0–10.2) for deep SSI in total hip prosthesis. In chest and abdominal surgeries, the impact was larger for superficial SSI than for deep SSI.
The results of our research provide evidence for the need of preventive programs targeting SSI in overweight and obese patients, as well as for the prevention of obesity in the general population.
FFQ, food diaries and 24 h recall methods represent the most commonly used dietary assessment tools in human studies on nutrition and health, but food intake biomarkers are assumed to provide a more objective reflection of intake. Unfortunately, very few of these biomarkers are sufficiently validated. This review provides an overview of food intake biomarker research and highlights present research efforts of the Joint Programming Initiative ‘A Healthy Diet for a Healthy Life’ (JPI-HDHL) Food Biomarkers Alliance (FoodBAll). In order to identify novel food intake biomarkers, the focus is on new food metabolomics techniques that allow the quantification of up to thousands of metabolites simultaneously, which may be applied in intervention and observational studies. As biomarkers are often influenced by various other factors than the food under investigation, FoodBAll developed a food intake biomarker quality and validity score aiming to assist the systematic evaluation of novel biomarkers. Moreover, to evaluate the applicability of nutritional biomarkers, studies are presently also focusing on associations between food intake biomarkers and diet-related disease risk. In order to be successful in these metabolomics studies, knowledge about available electronic metabolomics resources is necessary and further developments of these resources are essential. Ultimately, present efforts in this research area aim to advance quality control of traditional dietary assessment methods, advance compliance evaluation in nutritional intervention studies, and increase the significance of observational studies by investigating associations between nutrition and health.
Surveillance is an important strategy to reduce the incidence of surgical site infections (SSIs). We investigated whether prior, multiple-, or repetitive surgeries are risk factors for SSI and whether they should be preserved in the protocol of the Dutch national SSI surveillance network.
Dutch national SSI surveillance data 2012–2015 were selected, including 34 commonly performed procedures from 8 major surgical specialties. Definitions of SSIs followed international standardized criteria. We used multivariable multilevel logistic regression techniques to evaluate whether prior, multiple-, or repetitive procedure(s) are risk factors for SSIs. We considered surgeries clustered within partnerships of medical specialists and within hospitals (random effects) and different baseline risks between surgical specialties (fixed effects). Several patient and surgical characteristics were considered possible confounders and were included where necessary. We performed analyses for superficial and deep SSIs combined as well as separately.
In total, 115,943 surgeries were reported by 85 hospitals; among them, 2,960 (2.6%) resulted in SSIs (49.3% deep SSIs). The odds ratio (OR) for having prior surgery was 0.94 (95% confidence interval [CI], 0.74–1.20); the OR for repetitive surgery was 2.39 (95% CI, 2.06–2.77); and the OR for multiple surgeries was1.27 (95% CI, 1.07–1.51). The latter effect was mainly caused by prolonged duration of surgery.
Multiple- and repetitive surgeries significantly increased the risk of an SSI, whereas prior surgery did not. Therefore, prior surgery is not an essential data item to include in the national SSI surveillance network. The increased risk of SSIs for multiple surgeries was mainly caused by prolonged duration of surgery, therefore, it may be sufficient to report only duration of surgery to the surveillance network, instead of both (the variables duration of surgery and multiple surgeries).
A dedicated hyperthermia (HT) system was designed for tumors in intact breast extending beyond the heating depth of our superficial 434 MHz antennas, consisting of a treatment bed fitted with a 50 cm × 40 cm × 16 cm temperature controlled open water bolus. The patient lies in prone position with the breast immersed in the water positioned in front of a 34 cm × 20 cm 70 MHz waveguide operating in the TE10 mode. E-field patterns were measured in a tissue-mimicking phantom. HT was applied once a week with the 70 MHz applicator for six patients treated with thermoradiotherapy for deep lesions of recurrent breast cancer or melanoma. Two 14-sensor thermocouple thermometry probes were placed in catheters to monitor the invasive temperature. Results: Phantom measurements showed sufficient penetration depth up to 10 cm depth. The combination of 300–900 W antenna power and a water temperature of 42°C was well tolerated for the entire session of 1 h and resulted in good tumor temperatures with T90 = 39.8°C, T50 = 41.1°C, and T10 = 42.2°C. No toxicity or complaints were associated with the heating. A water mattress and other measures were needed to assure a comfortable position throughout the treatment. Conclusion: the 70 MHz breast applicator system performed well and tumor temperatures were good.
We have developed a fully automated cluster characterization pipeline, which simultaneously determines cluster membership and fits the fundamental cluster parameters: distance, reddening, and age. We present results for 24 established clusters and compare them to literature values. Given the large amount of stellar data for clusters available from Gaia DR2 in 2018, this pipeline will be beneficial to analyzing the parameters of open clusters in our Galaxy.
It is well known that comorbidity is the rule, not the exception, for categorically defined psychiatric disorders, and this is also the case for internalizing disorders of depression and anxiety. This theoretical review paper addresses the ubiquity of comorbidity among internalizing disorders. Our central thesis is that progress in understanding this co-occurrence can be made by employing latent dimensional structural models that organize psychopathology as well as vulnerabilities and risk mechanisms and by connecting the multiple levels of risk and psychopathology outcomes together. Different vulnerabilities and risk mechanisms are hypothesized to predict different levels of the structural model of psychopathology. We review the present state of knowledge based on concurrent and developmental sequential comorbidity patterns among common discrete psychiatric disorders in youth, and then we advocate for the use of more recent bifactor dimensional models of psychopathology (e.g., p factor; Caspi et al., 2014) that can help to explain the co-occurrence among internalizing symptoms. In support of this relatively novel conceptual perspective, we review six exemplar vulnerabilities and risk mechanisms, including executive function, information processing biases, cognitive vulnerabilities, positive and negative affectivity aspects of temperament, and autonomic dysregulation, along with the developmental occurrence of stressors in different domains, to show how these vulnerabilities can predict the general latent psychopathology factor, a unique latent internalizing dimension, as well as specific symptom syndrome manifestations.
There is an on-going debate among scholars from various disciplines about economic institutions and their impact on economic development. The case of the Amsterdam Chamber of Insurance is relevant to this discussion and in particular to the part that focuses on the nature and development of contract enforcement mechanisms. Marine insurance was introduced in Amsterdam in the mid-sixteenth century and soon the insurance industry developed into a prospering business. Its development was of great importance to the expansion of long-distance trade as it reduced the financial consequences of risks inherent to maritime trade. However, the new industry with its complex contracts was prone to misunderstandings, fraud and deception, creating the need for an independent, specialised court. The Chamber of Insurance was established as a generalised court, rather than a particularised court as was the case in cities that preceded Amsterdam’s trade dominance. Why did the Amsterdam municipality choose to set up this court and what were the implications? A recently discovered Statute Book of the Chamber gives insight into why the Chamber was established, how it functioned within the setting of Europe’s dominant trade centre and how it has affected the development of similar courts in the Netherlands.
The role of magnetic field in late type stars such as proto-planetary and planetary nebulae (PPNe/PNe), is poorly known from an observational point of view. We present submillimetric observations realized with the Submillimeter Array (SMA) which unveil the dust continuum polarization in the envelopes of two well known PPNe: CRL 618 and OH 231.8+4.2. Assuming the current grain alignment theory, we were then able to trace the geometry of the magnetic field.
Analyzing the development of the noun-to-verb ratio in a longitudinal corpus of four Chintang (Sino-Tibetan) children, we find that up to about age four, children have a significantly higher ratio than adults. Previous cross-linguistic research rules out an explanation of this in terms of a universal noun bias; instead, a likely cause is that Chintang verb morphology is polysynthetic and difficult to learn. This hypothesis is supported by the fact that the development of Chintang children's noun-to-verb ratio correlates significantly with the extent to which they show a similar flexibility with verbal morphology to that of the surrounding adults, as measured by morphological paradigm entropy. While this development levels off around age three, children continue to have a higher overall noun-to-verb ratio than adults. A likely explanation lies in the kinds of activities that children are engaged in and that are almost completely separate from adults' activities in this culture.
In 2004 the Netherlands Twin Register (NTR) started a large scale biological sample collection in twin families to create a resource for genetic studies on health, lifestyle and personality. Between January 2004 and July 2008, adult participants from NTR research projects were invited into the study. During a home visit between 7:00 and 10:00 am, fasting blood and morning urine samples were collected. Fertile women were bled on day 2–4 of the menstrual cycle, or in their pill-free week. Biological samples were collected for DNA isolation, gene expression studies, creation of cell lines and for biomarker assessment. At the time of blood sampling, additional phenotypic information concerning health, medication use, body composition and smoking was collected. Of the participants contacted, 69% participated. Blood and urine samples were collected in 9,530 participants (63% female, average age 44.4 (SD 15.5) years) from 3,477 families. Lipid profile, glucose, insulin, HbA1c, haematology, CRP, fibrinogen, liver enzymes and creatinine have been assessed. Longitudinal survey data on health, personality and lifestyle are currently available for 90% of all participants. Genome-wide SNP data are available for 3,524 participants, with additional genotyping ongoing. The NTR biobank, combined with the extensive phenotypic information available within the NTR, provides a valuable resource for the study of genetic determinants of individual differences in mental and physical health. It offers opportunities for DNA-based and gene expression studies as well as for future metabolomic and proteomic projects.
Folate deficiency during embryogenesis is an established risk factor for neural tube defects in the fetus. An adequate folate nutritional status is also important for normal fetal growth and brain development. The aim of the present research was to study the association between folic acid use of the mother during pregnancy and child behavioural development. Within a population-based cohort, we prospectively assessed folic acid supplement use during the first trimester by questionnaire. Child behavioural and emotional problems were assessed with the Child Behaviour Checklist at the age of 18 months in 4214 toddlers. Results showed that children of mothers who did not use folic acid supplements in the first trimester had a higher risk of total problems (OR 1·44; 95 % CI 1·12, 1·86). Folic acid supplement use protected both from internalising (OR of no supplement use 1·65; 95 % CI 1·24, 2·19) and externalising problems (OR 1·45; 95 % CI 1·17, 1·80), even when adjusted for maternal characteristics. Birth weight and size of the fetal head did not mediate the association between folic acid use and child behaviour. In conclusion, inadequate use of folic acid supplements during early pregnancy may be associated with a higher risk of behavioural problems in the offspring. Folic acid supplementation in early pregnancy, aimed to prevent neural tube defects, may also reduce mental health problems in children.
The effect of prior infection with cytomegalovirus (CMV) on progression of HIV disease in a cohort of 111 men with haemophilia was studied after 13 years followup. The relative hazards associated with CMV positivity on progression to AIDS, death and a CD4 count of 0·05 × 109/1 were 2·28, 2·42 and 2·34, respectively. CMV seropositive patients were significantly older than the seronegative and this was controlled for by using a Cox proportional hazards model. The relative hazards for the three endpoints decreased to 1·89, 1·82 and 1·93 respectively and were marginally non-significant (P = 0·05, 0·08 and 0·08 for the three endpoints respectively). We conclude that this cohort continues to show evidence of a ‘co-factor’ effect associated with prior infection with CMV which is confounded by age but not completely explained by age differences. The potential biological significance of these results is discussed in the context of recent controlled clinical trials which show a survival benefit from long-term high-dose acyclovir, a drug with activity in vivo against CMV and other herpesviruses.
Objectives: Constructive Technology Assessment (CTA) is a means to guide early implementation of new developments in society, and can be used as an evaluation tool for Coverage with Evidence Development (CED). We used CTA for the introduction of a new diagnostic test in the Netherlands, the 70-gene prognosis signature (MammaPrint®) for node-negative breast cancer patients.
Methods: Studied aspects were (organizational) efficiency, patient-centeredness and diffusion scenarios. Pre-post structured surveys were conducted in fifteen community hospitals concerning changes in logistics and teamwork as a consequence of the introduction of the 70-gene signature. Patient-centeredness was measured by questionnaires and interviews regarding knowledge and psychological impact of the test. Diffusion scenarios, which are commonly applied in industry to anticipate on future development and diffusion of their products, have been applied in this study.
Results: Median implementation-time of the 70-gene signature was 1.2 months. Most changes were seen in pathology processes and adjuvant treatment decisions. Physicians valued the addition of the 70-gene signature information as beneficial for patient management. Patient-centeredness (n = 77, response 78 percent): patients receiving a concordant high-risk and discordant clinical low/high risk-signature showed significantly more negative emotions with respect to receiving both test-results compared with concordant low-risk and discordant clinical high/low risk-signature patients. The first scenario was written in 2004 before the introduction of the 70-gene signature and identified hypothetical developments that could influence diffusion; especially the “what-if” deviation describing a discussion on validity among physicians proved to be realistic.
Conclusions: Differences in speed of implementation and influenced treatment decisions were seen. Impact on patients seems especially related to discordance and its successive communication. In the future, scenario drafting will lead to input for model-based cost-effectiveness analysis. Finally, CTA can be useful as a tool to guide CED by adding monitoring and anticipation on possible developments during early implementation, to the assessment of promising new technologies.
To realize ceramic/polymer nanocomposites for polymer waveguides, PMMA-coated Ta2O5 nanoparticles are synthesized as core/shell particles. Therefor a gas-phase process is used: the Karlsruhe Microwave Plasma Process. The organic coating is supposed to reduce the agglomeration of the ceramic cores and should facilitate the incorporation into the polymer resin. TEM investigations of the nanoparticles exhibit crystalline and amorphous Ta2O5 with sizes around 3 to 6 nm, confirmed by electron diffraction. Although the polymer coating is not visible in TEM imaging, electron energy loss spectroscopy (EELS) exhibits a significant C-edge, proofing the organic coating. The Ta2O5/PMMA nanoparticles are incorporated with different weight fractions to a maximum of 1 wt% by a dissolver stirrer into PMMA resin. The optical properties (refractive index, transmission) are determined as a function of the nanoparticle content. Compared to the pure polymer, the refractive index of the modified composite, measured at 633 nm, is increased by 0.001 and 0.004 at 0.1 wt% and 0.7 wt%, respectively. A similar tendency is observed at 1550 nm. The transmission in the near infrared (NIR) is similar to that of PMMA up to a content of 0.3 wt%. At higher nanoparticle contents transmission is reduced. The reduction in transmission is due to the presence of agglomerates larger then 1/10 of the applied wavelength, confirmed by TEM. The concept of incorporating inorganic/organic hybrid nanoparticles with intrinsic high refractive index in polymer matrices is very promising. A suitable effect in refractive index for application of ceramic nanoparticle/polymer nanocomposites as polymer waveguides could be observed even with low particle concentration.