Nierstichting

In the ICARUS project, European partners collaborate to develop and scale innovative technologies for recovering and refining secondary raw materials from silicon photovoltaic (PV) manufacturing. The production of photovoltaic modules generates significant quantities of waste, particularly silicon kerf, graphite, and silica residues from ingot and wafer manufacturing. ICARUS aims to transform these waste streams into high‐value secondary materials suitable for reintegration into the PV value chain and other industrial applications. Four industrial pilot‐scale processes are developed, targeting the purification and reuse of these materials. Results from the pilots demonstrate both the technical feasibility and economic potential of substituting these recovered materials for virgin and critical raw materials. This work provides a viable pathway toward a more resource‐efficient and circular PV manufacturing industry.

Abstract Improving the efficiency and competitiveness of European Shipyards is one of the priorities of the HORIZON program, funded by the European Commission. The proper use of computational tools can accelerate this improvement, given that the shipbuilding industry faces a digitalization gap compared to other manufacturing industries. Our proposal is based on the ongoing Smart European Shipyard (SEUS) project, which aims to bridge the digital gap, focusing on integrating available computational tools, and converging into a new platform that enables faster engineering and technical management. This platform intends to provide a holistic approach to product lifecycle management (PLM) for shipbuilding, integrating existing and proven solutions in CAD/CAE with new data-driven technologies to handle shipbuilding knowledge efficiently. The paper presents a link between current challenges and possible ways to tackle them and a summary of the possible impacts this platform can achieve if adequately implemented. The paper closes with a call for peers to contribute to the discussion.

• Ambition setting is essential for fostering transformations towards climate resilient futures. • Ambition setting connects envisioning futures with setting goals and actions to achieve them. • Climate services and tools can support ambition setting, illustrated by four examples. • Four key criteria for climate services and tools for ambition setting are defined. Climate change adaptation efforts need to accelerate and scale-up to deal with increasing climate change impacts worldwide in order to safeguard the resilience of societies. Currently adaptation action is merely following a risk-based planning approach, going from identifying a climate related risk to directly finding solutions. This has resulted into largely fragmented, local, and incremental adaptation actions up to present. There is a need for transformational change, and combining adaptation with other policy objectives, to speed up action towards climate resilient development. However, this integration alone may not be sufficient to address the systemic transformation required to tackle the root causes of existing challenges and underlaying vulnerabilities. A broader perspective is needed to envision the “future we want” and defining key goals and actions to achieve these futures. We believe that such an ambition setting process is critical, and commonly missing in adaptation planning. With ambition setting we mean a policy process that entails developing visions coupled with identifying goals and actions that work towards these visions. Ambition setting builds upon understanding the desired transformations in the system and the root cause of present challenges, including risks and vulnerabilities. To put ambition setting into practice climate services and tools can be employed. We identify key criteria supporting the selection of such tools and provide four examples showcasing how the tools support ambition setting. A tradition of ambition setting should be fostered, as well as tools and services should be further developed in parallel to accelerate transformations towards climate resilient development.

BackgroundThe need for patient engagement in health research has been increasingly acknowledged and accepted in recent years. However, implementation is still limited due to lack of evidence on its value and lack of guidance on how to implement patient engagement. This study aims to provide insight into the contribution of patient engagement in the RECOVAC project, which studied COVID-19 vaccination in kidney patients, and formulate concrete practice-based action perspectives for patient engagement.MethodsWe used a qualitative participatory mixed methods approach, based on the Patient Engagement Monitoring and Evaluation (PEME) framework. Patient engagement and data collection were based on the Reflexive Monitoring in Action (RMA) approach. Data collection included participant observations, open ended questionnaires and interactive reflection sessions. Qualitative analysis was done via a thematic approach.ResultsWe have described the process of patient engagement systematically, provided insight in its value and found that there is a need for clear aims, expectations and preparations from the start of the engagement process. We have shown that reflection throughout the process is of utmost importance and the same applies to clear communication between researchers and patient representatives. By being part of the consortium patient representatives had direct access to information, straight from the source, on for example the vaccination schedule and medication availability and had indirect influence on decisions made by the National Institute for Public Health and the Environment (RIVM) on preventive measures and treatment against COVID-19. Having experienced patient representatives is important, otherwise training needs to be provided. We also found that patient engagement had impact on conduct and outcomes of research activities itself and may have impact on future research and patient engagement activities in general.ConclusionPatient engagement has changed the course of the project. Concrete practice-based action perspectives have been formulated, which are already being implemented by the Dutch Kidney Patients Association (NVN). Studying patient engagement in a high pace project with high public interest has resulted in lessons learned and will help prepare and implement patient involvement in future research projects.Clinical trial registrationThe RECOVAC studies in which the patient engagement took place are registered at clinicialtrial.gov (NCT04741386 registration date 2021-02-04, NCT04841785 registration date 2021-03-22 and NCT05030974 registration date 2021-08-20).

Abstract Background and Aims Fatigue is a commonly reported symptom in all stages of chronic kidney disease (CKD) and has a major impact on patients’ daily lives. Until now, predominantly qualitative research has contributed to our knowledge about CKD patients' experiences and perceptions of fatigue, and this knowledge is mostly constrained to the dialysis population. Therefore, the aim of this survey study was to explore in all stages of CKD: 1) patients’ experienced burden of fatigue, its impact on their daily lives, and presumed causes of their fatigue; 2) patients’ experiences and needs related to support, discussion and treatment of fatigue. Method In The Netherlands, a survey was constructed, consisting of twenty multiple-choice questions and six open-ended questions, to assess patients’ demographics; experiences, burden and impact of fatigue; presumed causes of fatigue; perceived social support; and experiences and needs regarding discussion and treatment of fatigue during routine nephrology care. This web-based survey was developed together with and distributed by the Dutch Kidney Patients Association, and all surveys were completed between 10 January 2023 and 23 July 2023. Descriptive statistics were used to summarize the results, also stratified by CKD population (CKD prior to kidney replacement therapy [KRT], dialysis, and kidney transplantation [KT]), sex (male and female), and age (18-50, 50-70, and ≥70 years). Results In total, 385 Dutch patients completed the survey. Participants had a mean (standard deviation) age of 58.2 (13.5) years and 42% was male. Overall, results were quite similar for all CKD populations: CKD prior to KRT (n = 130), dialysis (n = 39), and KT (n = 216). More specifically, fatigue was often experienced in the previous month (range percentages across the CKD populations: 92-100%) and present for longer than 6 months (77-92%). The most frequently reported presumed cause of fatigue was related to the reduced kidney function (41%), followed by treatment-related factors (25%; e.g. medication and dialysis). Patients in all CKD populations reported a high burden of fatigue (76-87%) that belonged in the top three of most burdensome symptoms (79-87%). Compared to elderly patients, younger patients reported more often fatigue in mental, social, and emotional domains; hereby limiting them more often in education/work, social activities, and relationships/family life. In all age groups, the majority of patients experienced barriers in tasks within the household (71-83%). In 32% of all patients, fatigue was never or rarely discussed with the treating physician, with the most important reasons being that patients assumed fatigue is part of their disease, and the lack of attention and efforts from the physician to discuss or treat fatigue. Of those patients who did discuss fatigue, 67% did not receive any advice or treatment from their physician. Of those who did receive advice or treatment (e.g. physical exercise), most patients (58%) believed it did not help to feel less tired. Finally, patients prior to KRT, women, and patients aged 18-50 years, reported more often receiving insufficient social support (42-65%;37-60%). Many of them desired acknowledgment of their debilitating symptom burdens, and more information about treatments and coping strategies for fatigue and its consequences. Conclusion In all stages of CKD, patients experience a high fatigue burden and insufficient support for their fatigue. To address this high symptom burden and patients’ unmet needs, it is important to: structurally measure (the burden of) fatigue in all CKD stages (e.g. using PROMs), strengthen social support for patients who experience fatigue, ensure that symptoms such as fatigue are discussed during consultations, and improve multidisciplinary symptom management with special attention for embedding psychosocial educational support to deal with (the consequences of) fatigue. Further research is needed to develop and implement such multidisciplinary symptom (communication and treatment) strategies into routine nephrology care.

Conventionally, ship design and engineering are segregated activities, carried out with different software packages that thus each have their own place, qualities and tools. And consequently, a different data model. As a report on ongoing work to bridge that gap, this paper first explores existing neutral data models and standards employed or considered in maritime applications and concludes that none of these is directly applicable. It continues with describing the requirements and derived abstract data model of the SEUS project and its design and engineering applications. A graph database is identified as a potentially useful tool for SEUS data modelling, and a hands-on experiment confirms this presumption.

Subseasonal rainfall forecast skill is critical to support preparedness for hydrometeorological extremes. We assess how a process-informed evaluation, which subsamples forecasting model members based on their ability to represent potential predictors of rainfall, can improve monthly rainfall forecasts within Central America in the following month, using Costa Rica and Guatemala as test cases. We generate a constrained ensemble mean by subsampling 130 members from five dynamic forecasting models in the C3S multimodel ensemble based on their representation of both (a) zonal wind direction and (b) Pacific and Atlantic sea surface temperatures (SSTs), at the time of initialization. Our results show in multiple months and locations increased mean squared error skill by 0.4 and improved detection rates of rainfall extremes. This method is transferrable to other regions driven by slowly-changing processes. Process-informed subsampling is successful because it identifies members that fail to represent the entire rainfall distribution when wind/SST error increases.

SummaryBackgroundKidney transplant recipients (KTRs) were advised to tightly adhere to government recommendations to curb the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) because of a high risk of morbidity and mortality and decreased immunogenicity after vaccination. The aim of this study was to analyse the change in adherence to preventive measures after vaccination and awareness of antibody response, and to evaluate its effectiveness.MethodsIn this large-scale, national questionnaire study, questionnaires were sent to 3531 KTRs enrolled in the Dutch RECOVAC studies, retrospectively asking for adherence to nine preventive measures on a 5-point Likert scale before and after SARS-CoV-2 vaccination and after awareness of antibody response. Blood samples were collected 28 days after the second vaccination. Antibody response was categorised as non-responder (≤50 BAU/mL), low-responder (>50 ≤ 300 BAU/mL) or high-responder (>300 BAU/mL), and shared with participants as a correlate of protection. Participants of whom demographics on sex and age, blood samples and completed questionnaires were available, were included. Our study took place between February 2021 and January 2022. The primary outcome of adherence before and after vaccination was assessed between August and October 2021 and compared via the Wilcoxon signed rank sum test. Logistic regression analysis was performed to estimate the association between antibody response and non-adherence, and adherence on acquiring SARS-CoV-2 infection. This study is registered at ClinicalTrials.gov (NCT04841785).FindingsIn 2939 KTRs (83%) who completed the first questionnaire on adherence to preventive measures, adherence was higher before than after vaccination (4.56, IQR 4.11–4.78 and 4.22, IQR 3.67–4.67, p < 0.001). Adherence after awareness of antibody response was analysed in 2399 KTRs (82%) of whom also blood samples were available, containing 949 non-responders, 500 low-responders and 950 high-responders. Compared to non-responders, low- and high-responders reported higher non-adherence. Higher adherence was associated with lower infection rates before and after vaccination (OR 0.67 [0.51–0.91], p = 0.008 and OR 0.48 [0.28–0.86], p = 0.010).InterpretationAdherence decreased after SARS-CoV-2 vaccination and in KTRs who were aware of a subsequent antibody response compared with those without. Preventive measures in this vulnerable group seem to be effective, regardless of vaccination status. This study starts a debate on sharing antibody results with the patient and future studies should elucidate whether decreased adherence in antibody responders is justified, also in view of future pandemics.FundingThe Netherlands Organization for Health Research and Development and the 10.13039/501100002997Dutch Kidney Foundation.

Abstract Background and Aims Access to individualized, evidence-based prognostics is needed to facilitate shared decision making about the clinical implications of whether to opt for kidney transplantation or long-term dialysis. We aim to implement a data-driven support tool (Nierkeuze.nl) that incorporates basic patient characteristics and treatment options. Method Consecutive patients (N = 14.275) above 18 years of age with end-stage-renal-disease (ESRD) who were eligible candidates for their first kidney transplantation and started renal replacement therapy between 2000 and 2019 were included from the national registries RENINE and NOTR. SF-12 quality of life data was obtained from RENINE and a local transplant database. Several algorithms were developed to predict waiting time, short- and long-term patient survival, graft survival, and quality of life according to factors that are known at ESRD. Probabilities of 3- and 5-year mortality were calculated using two-stage distinct Cox regression: 1) waitlist-mortality according to median time on the waiting list, 2) mortality after transplantation in remaining follow-up. Product and complement rules defined the final probabilities. No mortality on the waiting list was assumed for living donor transplants. Missing data were imputed. Model performance was evaluated by internally validated C-statistics and calibration plots. Results We included 4.889 deceased donor transplants, of which 990 were within the Eurotransplant Senior allocation Program (ESP), and 6.251 living donor transplants. Discrimination varied for patient survival models (C-stats: 0.68 deceased-ETKAS-TX; 0.58 for deceased-ESP-TX; 0.74 for living-TX; 0.64 for waitlisted-candidates). Survival models achieved good calibration by visual inspection across the range of predicted probabilities. Figure 1 illustrates a clear 5-year survival benefit of transplantation (living and deceased donor groups) compared with wait-listed candidates for a 65-year-old male with glomerulonephritis. Other developed algorithms of the support tool will be presented with an overview of the first experiences in the kidney failure clinic. Conclusion Nierkeuze.nl depicts the influence of anticipated waiting time, patient characteristics, kidney allocation program, and donor type on survival outcome of the different treatment options. Incorporating this individualized quantitative outcome information may provide valuable support for an informed choice by patients and potential living donors.