BACKGROUND: Acute kidney injury (AKI) often occurs in critically ill patients. AKI is associated with mortality and morbidity. Interventions focusing on the reduction of AKI are suggested by the Kidney Disease: Improving Global Outcomes guideline. We hypothesized that these educational interventions would improve outcome in patients admitted to the Intensive Care Unit (ICU).METHODS: This was a pragmatic single-centre prospective observational before-after study design in an ICU in a tertiary referral hospital. All consecutive patients admitted to the ICU irrespective their illness were included. A 'Save the Kidney' (STK) bundle was encouraged via an educational intervention targeting health care providers. The educational STK bundle consisted of optimizing the fluid balance (based on urine output, serum lactate levels and/or central venous oxygen saturation), discontinuation of diuretics, maintaining a mean arterial pressure of at least 65 mmHg with the potential use of vasopressors and critical evaluation of the indication and dose of nephrotoxic drugs. The primary outcome was the composite of mortality, renal replacement therapy (RRT), and progression of AKI. Secondary outcomes were the components of the composite outcome the severity of AKI, ICU length of stay and in-hospital mortality.MAIN RESULTS: The primary outcome occurred in 451 patients (33%) in the STK group versus 375 patients (29%) in the usual care group, relative risk (RR) 1.16, 95% confidence interval (CI) 1.03-1.3, p < 0.001. Secondary outcomes were, ICU mortality in 6.8% versus 5.6%, (RR 1.22, 95% CI 0.90-1.64, p = 0.068), RRT in 1.6% versus 3.6% (RR 0.46, 95% CI 0.28-0.76, p = 0.002), and AKI progression in 28% versus 24% (RR 1.18, 95% CI 1.04-1.35, p = 0.001).CONCLUSIONS: Providing education to uniformly apply an AKI care bundle, without measurement of the implementation in a non-selected ICU population, targeted at prevention of AKI progression was not beneficial.
Conference organized by the Faculty of Social Sciences of Eötvös Loránd University, Hilscher Rezső Social Policy Association, Gyere Association and CARe Europe 3 Foreword 5 Section 1. Transition from institutional to recovery-oriented community care: challenges throughout Europe 5 Zsolt Bugarszki: Introduction 7 Jan Pfeiff er: Developments in Central and Eastern Europe with regard to transition from Institutional to Community Care 13 Robert van Voren: Reform of the mental health system in Eastern Europe and in the former Soviet Republics 17 Jean-Pierre Wilken: Developments in Western Europe with regard to transition from traditional to recovery oriented care 21 Dirk den Hollander: Recognition of power and the power of recognition
BACKGROUND: There is uncertainty about how much positive end-expiratory pressure (PEEP) should be used in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19).OBJECTIVE: To investigate whether a higher PEEP strategy is superior to a lower PEEP strategy regarding the number of ventilator-free days (VFDs).DESIGN: Multicentre observational study conducted from 1 March to 1 June 2020.SETTING AND PATIENTS: Twenty-two ICUs in The Netherlands and 933 invasively ventilated COVID-19 ARDS patients.INTERVENTIONS: Patients were categorised retrospectively as having received invasive ventilation with higher (n=259) or lower PEEP (n=674), based on the high and low PEEP/FIO2 tables of the ARDS Network, and using ventilator settings and parameters in the first hour of invasive ventilation, and every 8 h thereafter at fixed time points during the first four calendar days. We also used propensity score matching to control for observed confounding factors that might influence outcomes.MAIN OUTCOMES AND MEASURES: The primary outcome was the number of VFDs. Secondary outcomes included distant organ failures including acute kidney injury (AKI) and use of renal replacement therapy (RRT), and mortality.RESULTS: In the unmatched cohort, the higher PEEP strategy had no association with the median [IQR] number of VFDs (2.0 [0.0 to 15.0] vs. 0.0 [0.0 to 16.0] days). The median (95% confidence interval) difference was 0.21 (-3.34 to 3.78) days, P = 0.905. In the matched cohort, the higher PEEP group had an association with a lower median number of VFDs (0.0 [0.0 to 14.0] vs. 6.0 [0.0 to 17.0] days) a median difference of -4.65 (-8.92 to -0.39) days, P = 0.032. The higher PEEP strategy had associations with higher incidence of AKI (in the matched cohort) and more use of RRT (in the unmatched and matched cohorts). The higher PEEP strategy had no association with mortality.CONCLUSION: In COVID-19 ARDS, use of higher PEEP may be associated with a lower number of VFDs, and may increase the incidence of AKI and need for RRT.TRIAL REGISTRATION: Practice of VENTilation in COVID-19 is registered at ClinicalTrials.gov, NCT04346342.
MUSE supports the CIVITAS Community to increase its impact on urban mobility policy making and advance it to a higher level of knowledge, exchange, and sustainability.As the current Coordination and Support Action for the CIVITAS Initiative, MUSE primarily engages in support activities to boost the impact of CIVITAS Community activities on sustainable urban mobility policy. Its main objectives are to:- Act as a destination for knowledge developed by the CIVITAS Community over the past twenty years.- Expand and strengthen relationships between cities and stakeholders at all levels.- Support the enrichment of the wider urban mobility community by providing learning opportunities.Through these goals, the CIVITAS Initiative strives to support the mobility and transport goals of the European Commission, and in turn those in the European Green Deal.Breda University of Applied Sciences is the task leader of Task 7.3: Exploitation of the Mobility Educational Network and Task 7.4: Mobility Powered by Youth Facilitation.
Massafabricage in de (MKB) maakindustrie is aan het veranderen in flexibele fabricage en assemblage van kleine series, klantspecifieke onderdelen en eindproducten. Hiervoor zijn nieuwe systemen voor het MKB nodig, waarin robots en mensen samen kunnen werken en die zich snel kunnen aanpassen aan nieuwe productieomstandigheden met lage opstartkosten. De ambitie van het project ?(G)een Moer Aan!? is om het herconfigureren van een robotsysteem voor een nieuwe taak in een productieomgeving net zo eenvoudig en snel te maken als het gebruik van een smartphone. Zo?n benadering biedt kansen om de skills van de operator te benutten. De operator kent immers zijn processen en de robot wordt zijn hulpje. Op vraag van betrokken mkb partners is de focus gelegd op een repeterende productiehandeling die in veel sectoren voorkomt en die relatief veel arbeidstijd kost: het indraaien van moeren en bouten in een object. De centrale onderzoeksvraag van het project luidt: Hoe kan een operator een robot eenvoudig, snel en veilig inleren om assemblage handelingen te verrichten voor het snel en robuust verbinden van bouten, moeren en ringen met objecten? Resultaat van dit praktijkgerichte onderzoeksproject is een algemeen bruikbare en gevalideerde ontwerpmethodiek voor de opzet van een gebruiksvriendelijke user interface van een boutmontagerobot op de werkvloer. Door slim gebruik van geïntegreerde inzet van CAD productinformatie, vision technologie en compliant (meegaand) gripping en placing wordt de robot zo veel als mogelijk vooraf automatisch geconfigureerd. Het projectconsortium dat het onderzoek gaat uitvoeren bestaat uit: " 13 bedrijven (12 mkb) actief als toeleverancier, system integrator of gebruiker op het terrein van industriële robotica (Yaskawa, ABB, Smart Robotics, Hupico, Festo, CSi, Demcon, Heemskerk Innovate, WWA, Van Schijndel Metaal, Van Beek, Tegema en Zest Innovate); " Hogescholen Fontys (penvoerder), Avans, Utrecht en NHL; " Kennisinstellingen TNO en DIFFER; " Coöperaties Brainport Industries, FEDA en Koninklijke Metaalunie; " De gemeente Eindhoven is betrokken als partner in de klankbordgroep. De gemeente ondersteunt het belang van dit project voor behoud en verbetering van arbeidsplaatsen in de maakindustrie. Er zullen circa 20 (docent)onderzoekers van de hogescholen en ongeveer 80 studenten betrokken worden bij dit project, die in de vorm van stages en afstudeeronderzoeken werken aan interessante vraagstukken direct afkomstig uit de beroepspraktijk. Naast genoemde meerwaarde voor het bedrijfsleven beoogt het project een verdere verankering van kennis en kunde in onderwijs en lectoraten en een vergroting van de kwaliteit van docenten en afstudeerders.
Designing cities that are socially sustainable has been a significant challenge until today. Lately, European Commission’s research agenda of Industy 5.0 has prioritised a sustainable, human-centric and resilient development over merely pursuing efficiency and productivity in societal transitions. The focus has been on searching for sustainable solutions to societal challenges, engaging part of the design industry. In architecture and urban design, whose common goal is to create a condition for human life, much effort was put into elevating the engineering process of physical space, making it more efficient. However, the natural process of social evolution has not been given priority in urban and architectural research on sustainable design. STEPS stems from the common interest of the project partners in accessible, diverse, and progressive public spaces, which is vital to socially sustainable urban development. The primary challenge lies in how to synthesise the standardised sustainable design techniques with unique social values of public space, propelling a transition from technical sustainability to social sustainability. Although a large number of social-oriented studies in urban design have been published in the academic domain, principles and guidelines that can be applied to practice are large missing. How can we generate operative principles guiding public space analysis and design to explore and achieve the social condition of sustainability, developing transferable ways of utilising research knowledge in design? STEPS will develop a design catalogue with operative principles guiding public space analysis and design. This will help designers apply cross-domain knowledge of social sustainability in practice.
