Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
Previous research has shown clinical effectiveness of dermal substitution; however, in burn wounds, only limited effect has been shown. A problem in burn wounds is the reduced take of the autograft, when the substitute and graft are applied in one procedure. Recently, application of topical negative pressure (TNP) was shown to improve graft take. The aim of this study was to investigate if application of a dermal substitute in combination with TNP improves scar quality after burns. In a four-armed multicenter randomized controlled trial, a split-skin graft with or without a dermal substitute and with or without TNP was compared in patients with deep dermal or full-thickness burns requiring skin transplantation. Graft take and rate of wound epithelialization were evaluated. Three and 12 months postoperatively, scar parameters were measured. The results of 86 patients showed that graft take and epithelialization did not reveal significant differences. Significantly fewer wounds in the TNP group showed postoperative contamination, compared to other groups. Highest elasticity was measured in scars treated with the substitute and TNP, which was significantly better compared to scars treated with the substitute alone. Concluding, this randomized controlled trial shows the effectiveness of dermal substitution combined with TNP in burns, based on extensive wound and scar measurements.
Substitution is an essential tool for a coach to influence the match. Factors like the injury of a player, required tactical changes, or underperformance of a player initiates substitutions. This study aims to predict the physical performance of individual players in an early phase of the match to provide additional information to the coach for his decision on substitutions. Tracking data of individual players, except for goalkeepers, from 302 elite soccer matches of the Dutch ‘Eredivisie’ 2018–2019 season were used to enable the prediction of the individual physical performance. The players’ physical performance is expressed in the variables distance covered, distance in speed category, and energy expenditure in power category. The individualized normalized variables were used to build machine learning models that predict whether players will achieve 100%, 95%, or 90% of their average physical performance in a match. The tree-based algorithms Random Forest and Decision Tree were applied to build the models. A simple Naïve Bayes algorithm was used as the baseline model to support the superiority of the tree-based algorithms. The machine learning technique Random Forest combined with the variable energy expenditure in the power category was the most precise. The combination of Random Forest and energy expenditure in the power category resulted in precision in predicting performance and underperformance after 15 min in a match, and the values were 0.91, 0.88, and 0.92 for the thresholds 100%, 95%, and 90%, respectively. To conclude, it is possible to predict the physical performance of individual players in an early phase of the match. These findings offer opportunities to support coaches in making more informed decisions on player substitutions in elite soccer.
Carboxylated cellulose is an important product on the market, and one of the most well-known examples is carboxymethylcellulose (CMC). However, CMC is prepared by modification of cellulose with the extremely hazardous compound monochloracetic acid. In this project, we want to make a carboxylated cellulose that is a functional equivalent for CMC using a greener process with renewable raw materials derived from levulinic acid. Processes to achieve cellulose with a low and a high carboxylation degree will be designed.
This project is to investigate Circular Calcium Carbonate (CCC) that is produced by pyrolysis from paper waste in an innovative process developed by the company Alucha Management B.V. (Alucha) located in Arnhem. Although there is a need to use circular materials in rubber formulations it has not yet been proven that the replacement of mined white fillers (e.g. Kaolin, Calcium Carbonate) by CCC in rubber applications is possible without a significant impact on the processing properties and part performance. The scope of this project is to investigate the use of Circular Calcium Carbonate (CCC) in various rubber formulations and articles made thereof.
In order to decrease the environmental impact caused by the construction sector, biobased materials need to be further developed to allow better integration and acceptance in the market. Mycelium composites are innovative products, with intrinsic properties which rise the attention of architects, designers and industrial companies. Both mycelium foam and board material have the potential to substitute conventional toxic materials. The mechanical properties of these products are influenced by their production process. For example, bending and tensile strengths have shown to be higher in heat pressed samples (F. V.W. Appels, 2019). The heat press process related to mycelium boards, needs further development in terms of process timing and of parameters, as temperature, pressure and duration of pressing. It is the need to research mycelium boards which drove the partner companies to approach the Centre of Expertise BioBased Economy (CoEBBE). The project partners are the following: KNN Cellulose BV, Fungalogic and V8 Architects. The interest of each partner is focused on different aspects of mycelium boards, which can be summarised in the following questions: • Is it possible to use cellulose to produce mycelium composites? (KNN Cellulose) • What are the different production parameters and how can these be optimized? (V8 Architects, Fungalogic) • What are the mechanical material properties and (how) can mycelium boards be used for interior or construction purposes? (V8 Architects, Fungalogic) These questions merge together in the research question: is it possible to create a mycelium board with cellulose biomass that can be used as a substitution of conventional board materials? The developed research will bring specific knowledge to each involved partner. In particular, KNN Cellulose will have a new application for their product; Fungalogic will acquire knowledge on board materials and have a potential new product; V8 Architects will gain specific knowledge on mycelium products.
