BC Broekhin Roermond

Introduction and aim Refractory dyspnea is a common symptom in advanced COPD, with a high negative impact. As treatment for refractory dyspnea, opioids -mostly morphine- have been investigated and made their way into palliative care guidelines. But in recent years there have been multiple negative studies in COPD. Furthermore, there is no RCT investigating transdermal fentanyl. We aimed to investigate whether both morphine and fentanyl are more effective than placebo for refractory dyspnea in COPD. <bold>Methods:</bold> This was a multicenter, cross-over, dubbel-dummy RCT, investigating fentanyl (patch,12mcg/hr), morphine (10 mg p.o. bid) and placebo, during 3 periods of 2 weeks (incl. 3 days wash out). Patients with stable COPD, FEV1<50%, and mMRC score≥3 with refractory dyspnea caused by COPD despite optimal therapy were included. <bold>Results:</bold> Between 2019 and 2024, 59 participants were included (69±7 years, 54% female, FEV1 33±10%), of which 37 completed all three study periods. The main reasons for discontinuation were exacerbations (n=13) and side effects (n=7). There were no significant differences between both fentanyl and morphine compared to placebo with respect to mean and worst dyspnea, sleep quality, health-related quality of life, mastery, anxiety or capillary blood gas analysis (table 1). <bold>Conclusion:</bold> This study demonstrated no positive effect of both morphine and fentanyl compared to placebo in the treatment of refractory dyspnea in COPD. <fig><object-id>erj;66/suppl_69/OA1188/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

This article discusses how to innovate STEM learning and education in- and outside of the classroom. It proposes to use a holistic framework for pupil-centered learning processes called Learn STEM. It was developed by an international research consortium based on the findings from mixed methods research. The research included a literature review, semi-structured interviews and three online surveys with the participation of teachers (n = 217), headmasters (n = 24) and learners (n = 354) from more than ten countries. Furthermore, the findings from the mixed methods research are also informing the international research consortium to design a teacher training programme and to develop an online course. This article provides first summaries of the research results related to the holistic pedagogical model and to the training programme. After a short overview of the final holistic pedagogical model Learn STEM, the paper presents one example how the holistic pedagogical model Learn STEM can be used for improving STEM learning and education outside the classroom. Finally, an outlook for future research is focused.

Abstract Background: The levonorgestrel-releasing–intrauterine system (LNG-IUS) is a frequently used method of contraception worldwide. A rare, but bothersome complication of the LNG-IUS is a perfo...

Abstract The world is undergoing a process of rapid urbanisation (Figure 1). Half of the world’s population now live in cities and according to the United Nations this proportion is set to rise to 70% in 20501. Globalisation and the emergence of a worldwide network society are simultaneously the cause and consequence of this urbanisation process2. Cities in this society assume many forms: in addition to the traditional central cities (Paris, Berlin, Moscow) there are extended mega cities (New York, Tokyo, Mumbai, Beijing) or yet bigger areas, sometimes deltas, which become completely urbanised, such as the Pearl River Delta in South China or the Southern Yangtze Delta between Shanghai and Nanjing. Our own environment is described by urban planners as a ‘polycentric metropolis’; some people restrict this to the Randstad, others mean the Dutch city ring and still others have the Northwest European Delta in mind3. Urbanisation is highly evolved in Europe and North America. Figure 1 shows that the major population concentrations are in Asia and Africa, and it is precisely there that urbanisation is happening most rapidly. It is to cities that people look for financial security, a better education for their children and job prospects, and they migrate there in great numbers for these reasons. In cities an antithesis is emerging between spaces of flows, which jointly shape the worldwide network society, and spaces of places, which give each city its own identity, history and uniqueness. In terms of space many metropolises are a sequence of built-up places and open spaces, formerly known as countryside. Where there was, in the past, a sharp division between city and countryside, this distinction has disappeared in and around metropolises. In the polycentric metropolis of North West Europe it has certainly become increasingly difficult to identify places that are rural in the traditional sense of the word. The city is everywhere.KeywordsSystem InnovationPearl River DeltaSpatial PlanningIndustrial EcologyNetwork SocietyThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Pervasive refusal syndrome (PRS) is a rare child psychiatric disorder characterized by pervasive refusal, active/angry resistance to help and social withdrawal leading to an endangered state. Little has been written about PRS. A literature search yielded only 15 relevant articles, all published between 1991 and 2006. This article presents a critical review of the published literature, illustrated by a case report of an 11-year-old girl. PRS most often affects girls (75%). The mean age of the known population is 10.5 years. A premorbid high-achieving, perfectionist, conscientious personality seems to play an important role in the aetiology of PRS, as can a psychiatric history of parents or child and environmental stressors. PRS shows a symptom overlap with many other psychiatric disorders. However, none of the current DSM diagnoses can account for the full range of symptoms seen in PRS, and the active/angry resistance can be considered as the main distinguishing feature. Treatment should be multidisciplinary and characterized by patience, gentle encouragement and tender loving care. Hospitalization, ideally in a child and adolescent psychiatric unit, is almost always required. Although the recovery process is painfully slow (average duration of therapy 12.8 months), most children recover fully (complete recovery in 67% of known cases). In our opinion, it is important to increase knowledge of PRS, not only because of its disabling, potential life-threatening character, but also because there is hope for recovery through suitable treatment. We therefore propose an incorporation of PRS into the DSM and ICD classifications. However, an adaptation of the current diagnostic criteria is needed. We also consider PRS closely related to regression, which is why we introduce a new concept: “the refusal–withdrawal–regression spectrum”.

Colorectal cancer is a leading cause of morbidity and mortality, with approximately 300,000 new cases and 200,000 related deaths in Europe and the USA each year. Adjuvant treatment of colorectal cancer is now widely accepted and can reduce mortality with approximately 10%. This can be considered as one of the major achievements in oncology from the past decade. Current results will be discussed and strategies for the future will be outlined, including on-going or planned large-scale trials with new drugs and approaches.

Within the holding of Bührmann-Tetterode NV, 7 Dutch paper and board mills are operating, all of them using mainly waste paper as raw material. While three of them completely closed their watercircuits, two other mills put into practice biological waste water treatment namely anaerobic and anaerobic/aerobic. Number 6 is realising an anaerobic plant this year and for number 7 research is still being carried out, dealing with several unfavourable aspects. In September 1981 research for anaerobic treatment (UASB reactors) was started. After good results had been achieved on laboratory scale (301), further investigations were started on semitechnical scale (50 m3). In both cases the anaerobic seed sludge granulated after a while and loadings up to 20 kg COD/m3.d could be handled. COD-removal was 70 per cent, even when the hydraulic retention time was only 2.5 hours. In April 1983 a 70 m3 practical scale UASB reactor was started up at the solid board mill of Ceres. In October 1983 a full scale plant was started up at Papierfabriek Roermond. This plant consists of a 1,000 m3 UASB reactor and a 70 m3 gasholder. It has been designed and constructed by Paques BV and is used for pretreatment of effluent, in order to reduce the loading of the activated sludge plant. Besides energy savings on the oxygen input, about 1 million m3/year of biogas is being generated and is used for steamproduction. Both plants are working satisfactorily. Investment costs appeared to be relatively low. At Ceres, pay-out time is 1.5 year, while at Papierfabriek Roermond waste water treatment is cheaper than before, although capacity is doubled.