| 1. |
- de Vries, Arjen E., et al.
(författare)
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Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients
- 2013
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central. - 1472-6947. ; 13:54
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundClinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T).MethodsA questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed.ResultsThe response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01).ConclusionsBoth cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.
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| 2. |
- Okada, Yukinori, et al.
(författare)
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Genetics of rheumatoid arthritis contributes to biology and drug discovery
- 2014
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Ingår i: Nature. - : Nature Publishing Group. - 0028-0836 .- 1476-4687. ; 506:7488, s. 376-381
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Tidskriftsartikel (refereegranskat)abstract
- A major challenge in human genetics is to devise a systematic strategy to integrate disease-associated variants with diverse genomic and biological data sets to provide insight into disease pathogenesis and guide drug discovery for complex traits such as rheumatoid arthritis (RA)(1). Here we performed a genome-wide association study meta-analysis in a total of >100,000 subjects of European and Asian ancestries (29,880 RA cases and 73,758 controls), by evaluating similar to 10 million single-nucleotide polymorphisms. We discovered 42 novel RA risk loci at a genome-wide level of significance, bringing the total to 101 (refs 2-4). We devised an in silico pipeline using established bioinformatics methods based on functional annotation(5), cis-acting expression quantitative trait loci(6) and pathway analyses(7-9)-as well as novel methods based on genetic overlap with human primary immunodeficiency, haematological cancer somatic mutations and knockout mouse phenotypes-to identify 98 biological candidate genes at these 101 risk loci. We demonstrate that these genes are the targets of approved therapies for RA, and further suggest that drugs approved for other indications may be repurposed for the treatment of RA. Together, this comprehensive genetic study sheds light on fundamental genes, pathways and cell types that contribute to RA pathogenesis, and provides empirical evidence that the genetics of RA can provide important information for drug discovery.
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| 3. |
- de Vries, Arjen E, et al.
(författare)
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Follow-up and treatment of an instable patient with heart failure using telemonitoring and a computerised disease management system : A case report
- 2012
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Ingår i: European Journal of Cardiovascular Nursing. - London, UK : Sage Publications. - 1474-5151 .- 1873-1953. ; 11:4, s. 432-438
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Tidskriftsartikel (refereegranskat)abstract
- In the last decades, the introduction of information and communication technology (ICT) in healthcare promised an improved quality of care while reducing workload and improving cost-effectiveness. This might be realised by the use of computer guided decision support systems and telemonitoring. This case study describes the process of care of a patient with chronic heart failure, who was treated with a computerised disease management system in combination with telemonitoring. With the help of these appliances, we think we were probably able to prevent at least two readmissions for heart failure in a period of 10months. We also gained more insight into patient's behaviour with regards to compliance with the heart failure regimen at home. Frequent contact at distance and the online availability of physiological measurements at home facilitated patient tailored education and helped the patient to react adequately to symptoms of deterioration. Additionally, up-titration of heart failure medication was performed without contacting the patient at the outpatient clinic.
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| 4. |
- de Vries, Arjen E., et al.
(författare)
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Health Professionals Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics
- 2013
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Ingår i: Journal of Medical Internet Research. - : Journal of Medical Internet Research / Gunther Eysenbach. - 1438-8871. ; 15:1, s. 73-83
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined. less thanbrgreater than less thanbrgreater thanObjective: To assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands. less thanbrgreater than less thanbrgreater thanMethods: In collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics. less thanbrgreater than less thanbrgreater thanResults: Of the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are "monitoring physical condition", "monitoring signs of deterioration" (n=39, 91%), "monitoring treatment" (n=32, 74%), "adjusting medication" (n=24, 56%), and "educating patients" (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system "as long as needed" or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (Pandlt;.001). Health care professionals experienced the most changes related to the use of telemonitoring in their work, in particular with respect to "keeping up with current development" (before 7.2, after 6.8, P=.15), "being innovative" (before 7.0, after 6.1, P=.003), and "better guideline adherence" (before 6.3, after 5.3, P=.005). Strikingly, 20 out of 31 heart failure clinics stated that they were considering using a different telemonitoring system than the system used at the time. less thanbrgreater than less thanbrgreater thanConclusions: One third of all heart failure clinics surveyed were using telemonitoring as part of their care without any transparent, predefined criteria of user requirements. Prior expectations of telemonitoring were not reflected in actual experiences, possibly leading to disappointment. (J Med Internet Res 2013;15(1):e4) doi:10.2196/jmir.2161
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| 5. |
- de Vries, Arjen E, et al.
(författare)
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The value of INnovative ICT guided disease management combined with Telemonitoring in OUtpatient clinics for Chronic Heart failure patients. Design and methodology of the IN TOUCH study : a multicenter randomised trial
- 2011
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Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 11, s. 167-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although the value of telemonitoring in heart failure patients is increasingly studied, little is known about the value of the separate components of telehealth: ICT guided disease management and telemonitoring. The aim of this study is to investigate the value of telemonitoring added to ICT guided disease management (DM) on the quality and efficiency of care in patients with chronic heart failure (CHF) after a hospitalisation.METHODS/DESIGN: The study is divided in two arms; a control arm (DM) and an intervention arm (DM+TM) in 10 hospitals in the Netherlands. In total 220 patients will be included after worsening of CHF (DM: N = 90, DM+TM: N = 130). Total follow-up will be 9 months. Data will be collected at inclusion and then after 2 weeks, 4.5 and 9 months. The primary endpoint of this study is a composite score of: 1: death from any cause during the follow-up of the study, 2: first readmission for HF and 3: change in quality of life compared to baseline, assessed by the Minnesota Living with Heart failure Questionnaire. The study has started in December 2009 and results are expected in 2012.CONCLUSIONS: The IN TOUCH study is the first to investigate the effect of telemonitoring on top of ICT guided DM on the quality and efficiency of care in patients with worsening HF and will use a composite score as its primary endpoint.TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR1898.
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| 6. |
- Chr Germs, Wijnand, et al.
(författare)
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High-efficiency dielectrophoretic ratchet
- 2012
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Ingår i: Physical Review E. Statistical, Nonlinear, and Soft Matter Physics. - : American Physical Society. - 1539-3755 .- 1550-2376. ; 86:4
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Tidskriftsartikel (refereegranskat)abstract
- Brownian ratchets enable the use of thermal motion in performing useful work. They typically employ spatial asymmetry to rectify nondirected external forces that drive the system out of equilibrium (cf. running marbles on a shaking washboard). The major application foreseen for Brownian ratchets is high-selectivity fractionation of particle or molecule distributions. Here, we investigate the functioning of an important model system, the on/off ratchet forwater-suspended particles, in which interdigitated finger electrodes can be switched on and off to create a time-dependent, spatially periodic but asymmetric potential. Surprisingly, we find that mainly dielectrophoretic rather than electrophoretic forces are responsible for the ratchet effect. This has major implications for the (a) symmetry of the ratchet potential and the settings needed for optimal performance. We demonstrate that by applying a potential offset the ratchet can be optimized such that its particle displacement efficiency reaches the theoretical upper limit corresponding to the electrode geometry and particle size. Efficient fractionation based on size selectivity is therefore not only possible for charged species, but also for uncharged ones, which greatly expands the applicability range of this type of Brownian ratchet.
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| 7. |
- de Vries, B. L., et al.
(författare)
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Comet-like mineralogy of olivine crystals in an extrasolar proto-Kuiper belt
- 2012
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 490:7418, s. 74-76
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Tidskriftsartikel (refereegranskat)abstract
- Some planetary systems harbour debris disks containing planetesimals such as asteroids and comets(1). Collisions between such bodies produce small dust particles(2), the spectral features of which reveal their composition and, hence, that of their parent bodies. A measurement of the composition of olivine crystals (Mg2-2xFe2xSiO4) has been done for the protoplanetary disk HD 100546 (refs 3, 4) and for olivine crystals in the warm inner parts of planetary systems. The latter compares well with the iron-rich olivine in asteroids(5,6) (x approximate to 0.29). In the cold outskirts of the beta Pictoris system, an analogue to the young Solar System, olivine crystals were detected(7) but their composition remained undetermined, leaving unknown how the composition of the bulk of Solar System cometary olivine grains compares with that of extrasolar comets(8,9). Here we report the detection of the 69-micrometre-wavelength band of olivine crystals in the spectrum of beta Pictoris. Because the disk is optically thin, we can associate the crystals with an extrasolar proto-Kuiper belt a distance of 15-45 astronomical units from the star (one astronomical unit is the Sun-Earth distance), determine their magnesium-rich composition (x = 0.01 +/- 0.001) and show that they make up 3.6 +/- 1.0 per cent of the total dust mass. These values are strikingly similar to those for the dust emitted by the most primitive comets in the Solar System(8-10), even though beta Pictoris is more massive and more luminous and has a different planetary system architecture.
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| 8. |
- Edvinsson, Lars, et al.
(författare)
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Effect of the calcitonin gene-related peptide (CGRP) receptor antagonist telcagepant in human cranial arteries.
- 2010
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Ingår i: Cephalalgia. - : SAGE Publications. - 0333-1024 .- 1468-2982. ; 30:10, s. 1233-1240
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Calcitonin gene-related peptide (CGRP) is a neuronal messenger in intracranial sensory nerves and is considered to play a significant role in migraine pathophysiology. MATERIALS AND METHODS: We investigated the effect of the CGRP receptor antagonist, telcagepant, on CGRP-induced cranial vasodilatation in human isolated cerebral and middle meningeal arteries. We also studied the expression of the CGRP receptor components in cranial arteries with immunocytochemistry. Concentration response curves to αCGRP were performed in human isolated cerebral and middle meningeal arteries in the absence or presence of telcagepant. Arterial slices were stained for RAMP1, CLR and actin in a double immunofluorescence staining. RESULTS: In both arteries, we found that: (i) telcagepant was devoid of any contractile or relaxant effects per se; (ii) pretreatment with telcagepant antagonised the αCGRP-induced relaxation in a competitive manner; and (iii) immunohistochemistry revealed expression and co-localisation of CLR and RAMP1 in the smooth muscle cells in the media layer of both arteries. CONCLUSIONS: Our findings provide morphological and functional data on the presence of CGRP receptors in cerebral and meningeal arteries, which illustrates a possible site of action of telcagepant in the treatment of migraine.
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| 9. |
- Greaves, J. S., et al.
(författare)
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Extreme Conditions in a Close Analog to the Young Solar System: Herschel Observations of ∈ Eridani
- 2014
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Ingår i: Astrophysical Journal Letters. - : American Astronomical Society. - 2041-8213 .- 2041-8205. ; 791:1
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Tidskriftsartikel (refereegranskat)abstract
- Far-infrared Herschel images of the is an element of Eridani system, seen at a fifth of the Sun's present age, resolve two belts of debris emission. Fits to the 160 mu m PACS image yield radial spans for these belts of 12-16 and 54-68 AU. The south end of the outer belt is approximate to 10% brighter than the north end in the PACS+SPIRE images at 160, 250, and 350 mu m, indicating a pericenter glow attributable to a planet "c" From this asymmetry and an upper bound on the offset of the belt center, this second planet should be mildly eccentric (e(c) approximate to 0.03-0.3). Compared to the asteroid and Kuiper Belts of the young Sun, the is an element of Eri belts are intermediate in brightness and more similar to each other, with up to 20 km sized collisional fragments in the inner belt totaling approximate to 5% of an Earth mass. This reservoir may feed the hot dust close to the star and could send many impactors through the Habitable Zone, especially if it is being perturbed by the suspected planet is an element of Eri b, at semi-major axis approximate to 3 AU.
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| 10. |
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| 11. |
- Roeling, Erik M., et al.
(författare)
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Organic electronic ratchets doing work
- 2011
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Ingår i: Nature Materials. - : Nature Publishing Group. - 1476-1122 .- 1476-4660. ; 10:1, s. 51-55
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Tidskriftsartikel (refereegranskat)abstract
- The possibility to extract work from periodic, undirected forces has intrigued scientists for over a century-in particular, the rectification of undirected motion of particles by ratchet potentials, which are periodic but asymmetric functions. Introduced by Smoluchowski and Feynman(1,2) to study the (dis)ability to generate motion from an equilibrium situation, ratchets operate out of equilibrium, where the second law of thermodynamics no longer applies. Although ratchet systems have been both identified in nature(3,4) and used in the laboratory for the directed motion of microscopic objects(5-9), electronic ratchets(10-13) have been of limited use, as they typically operate at cryogenic temperatures and generate subnanoampere currents and submillivolt voltages(10-14). Here, we present organic electronic ratchets that operate up to radio frequencies at room temperature and generate currents and voltages that are orders of magnitude larger. This enables their use as a d.c. power source. We integrated the ratchets into logic circuits, in which they act as the d.c. equivalent of the a. c. transformer, and generate enough power to drive the circuitry. Our findings show that electronic ratchets may be of actual use.
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| 12. |
- Roeling, Erik M., et al.
(författare)
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Scaling of characteristic frequencies of organic electronic ratchets
- 2012
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Ingår i: Physical Review B. Condensed Matter and Materials Physics. - : American Physical Society. - 1098-0121 .- 1550-235X. ; 85:4
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Tidskriftsartikel (refereegranskat)abstract
- The scaling of the characteristic frequencies of electronic ratchets operating in a flashing mode is investigated by measurements and numerical simulations. The ratchets are based on organic field effect transistors operated in accumulation mode. Oscillating potentials applied to asymmetrically spaced interdigitated finger electrodes embedded in the gate dielectric create a time-dependent, spatially asymmetric perturbation of the transistor channel potential. As a result, a net dc current can flow between source and drain despite zero source-drain bias. The frequency at current maximum is linearly dependent on the charge carrier density and the charge carrier mobility and inversely proportional to the squared length of the ratchet period, which can be related to the RC time of one asymmetric unit. Counterintuitively, it is independent of driving amplitude. Furthermore, the frequency at current maximum depends on the asymmetry of the ratchet potential, whereas the frequency of maximum charge pumping efficiency does not.
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| 13. |
- Roeling, Erik M., et al.
(författare)
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The performance of organic electronic ratchets
- 2012
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Ingår i: AIP Advances. - : American Institute of Physics (AIP): Open Access Journals / AIP Publishing LLC. - 2158-3226. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- Organic electronic ratchets rectify time-correlated external driving forces, giving output powers that can drive electronic circuitry. In this work their performance characteristics are investigated using numerical modeling and measurements. It is shown how the characteristic parameters of the time-varying asymmetric potential like length scales and amplitude, as well as the density and mobility of the charge carriers in the device influence the performance characteristics. Various ratchet efficiencies and their relations are discussed. With all settings close to optimum, a ratchet with charge displacement and power efficiencies close to 50% and 7% respectively is obtained. Copyright 2012 Author(s). This article is distributed under a Creative Commons Attribution 3.0 Unported License. [doi:10.1063/1.3677934]
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