Background: Post-term pregnancy, a pregnancy exceeding 294 days or 42 completed weeks, is associated with increased perinatal morbidity and mortality and is considered a high-risk condition which requires specialist surveillance and induction of labour. However, there is uncertainty on the policy concerning the timing of induction for post-term pregnancy or impending post-term pregnancy, leading to practice variation between caregivers. Previous studies on induction at or beyond 41 weeks versus expectant management showed different results on perinatal outcome though conclusions in meta-analyses show a preference for induction at 41 weeks. However, interpretation of the results is hampered by the limited sample size of most trials and the heterogeneity in design. Most control groups had a policy of awaiting spontaneous onset of labour that went far beyond 42 weeks, which does not reflect usual care in The Netherlands where induction of labour at 42 weeks is the regular policy. Thus leaving the question unanswered if induction at 41 weeks results in better perinatal outcomes than expectant management until 42 weeks. Methods/design: In this study we compare a policy of labour induction at 41 + 0/+1 weeks with a policy of expectant management until 42 weeks in obstetrical low risk women without contra-indications for expectant management until 42 weeks and a singleton pregnancy in cephalic position. We will perform a multicenter randomised controlled clinical trial. Our primary outcome will be a composite outcome of perinatal mortality and neonatal morbidity. Secondary outcomes will be maternal outcomes as mode of delivery (operative vaginal delivery and Caesarean section), need for analgesia and postpartum haemorrhage (≥1000 ml). Maternal preferences, satisfaction, wellbeing, pain and anxiety will be assessed alongside the trial. Discussion: his study will provide evidence for the management of pregnant women reaching a gestational age of 41 weeks.
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In this review article, the authors contextualize the contemporary practice of medical tourism in terms of the concept of worldmaking, which was introduced (in this journal) with two articles a year or two ago by Hollinshead. Here, the authors first contextualize medical tourism in terms of "worldmaking" per medium of the observations of the corporeal realms identified by Alexis de Tocqueville almost 200 years ago. In 1835, de Tocqueville wrote with enthusiasm tinged with nostalgic regret about the new world of American democracy that he then saw as the world of the future. A serious rupture in history took place of which he became a most relevant critic. But there have been (according to Mainil, Platenkamp, and Meulemans) many ruptures since then: that is, there have been short periods of "in-between worlds" that became ever more anchored in the timeline of Western history. Today, they argue that tourism as a field of expertise, practice, and knowledge is intertwined with several other networks of expertise. It is responsible (itself) for many small "ruptures" in these modern times. Mass tourism can be seen as such a shift. Sustainable tourism and the attention paid to climate change would be another such shift. And the authors of this review argue that an interesting and deep-seated case in this regard is medical tourism. They argue here that medical tourism has a great deal of worldmaking capacity, especially by means of the Internet and international marketing tools. It arises in the interstices of the interacting networks of a global world. It crosses borders in line with emerging power structures in a global network, but it also meets local resistance or regional obstacles that are related to other networks. In between these worlds of human experience, various interactions of perspectives on the concept of health itself come to the surface. Within the field of medical tourism different stakeholders play a role in a worldmaking process. Our reviewers from the Low Countries thereby argue that medical tourism itself is responsible for a Tocquevillean rupture within and across our global network society. In their view, medical tourism also constitutes a new hybrid-that is, as a hybrid medical paradigm that seems to be appearing within the performative and productive world of tourism.
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This is a review of the literature on community energy. We analyze more than 250 studies that appeared in the academic literature in the period 1997-2018. We investigate the timing regarding the appearance of these studies, the geographical orientation of the research, and the journals in which the articles appeared. We also analyse the keywords used to identify the research. Further, we relate the articles to the theoretical perspectives employed. We also analyse keywords used by the authors in relation to the particular approaches employed and reflect on the country specifics of the case studies. We find that the majority of studies on community energy did appear in the last couple of years. Especially the UK, US, Germany and the Netherlands are being investigated. Energy Policy published most of the studies. Different theoretical perspectives study community energy, especially Governance, Sociology, Economics, Planning, Technology, and Transition. We conclude that the study of community energy is still in its infancy as there is little commonality in the terminology and key concepts used. Studying community energy requires further improvement in order to better integrate the different theoretical perspectives and to ground policy decisions.
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The project aim is to improve collusion resistance of real-world content delivery systems. The research will address the following topics: • Dynamic tracing. Improve the Laarhoven et al. dynamic tracing constructions [1,2] [A11,A19]. Modify the tally based decoder [A1,A3] to make use of dynamic side information. • Defense against multi-channel attacks. Colluders can easily spread the usage of their content access keys over multiple channels, thus making tracing more difficult. These attack scenarios have hardly been studied. Our aim is to reach the same level of understanding as in the single-channel case, i.e. to know the location of the saddlepoint and to derive good accusation scores. Preferably we want to tackle multi-channel dynamic tracing. • Watermarking layer. The watermarking layer (how to embed secret information into content) and the coding layer (what symbols to embed) are mostly treated independently. By using soft decoding techniques and exploiting the “nuts and bolts” of the embedding technique as an extra engineering degree of freedom, one should be able to improve collusion resistance. • Machine Learning. Finding a score function against unknown attacks is difficult. For non-binary decisions there exists no optimal procedure like Neyman-Pearson scoring. We want to investigate if machine learning can yield a reliable way to classify users as attacker or innocent. • Attacker cost/benefit analysis. For the various use cases (static versus dynamic, single-channel versus multi-channel) we will devise economic models and use these to determine the range of operational parameters where the attackers have a financial benefit. For the first three topics we have a fairly accurate idea how they can be achieved, based on work done in the CREST project, which was headed by the main applicant. Neural Networks (NNs) have enjoyed great success in recognizing patterns, particularly Convolutional NNs in image recognition. Recurrent NNs ("LSTM networks") are successfully applied in translation tasks. We plan to combine these two approaches, inspired by traditional score functions, to study whether they can lead to improved tracing. An often-overlooked reality is that large-scale piracy runs as a for-profit business. Thus countermeasures need not be perfect, as long as they increase the attack cost enough to make piracy unattractive. In the field of collusion resistance, this cost analysis has never been performed yet; even a simple model will be valuable to understand which countermeasures are effective.
Het wereldwijd stijgende verbruik van fossiele brandstoffen leidt tot verhoogde broeikasgasemissies en tot onomkeerbare klimaatveranderingen. Als onderdeel van de energietransitie worden duurzame alternatieven zoals biobrandstoffen ontwikkeld. Het doel van dit project is om te onderzoeken of het haalbaar is om een innovatieve hernieuwbare bio-kerosine te ontwikkelen. Triacylglycerol (TAG), een potentiële biobrandstof, wordt door bacteriën zoals Nocardia en Rhodococcus tot zeer hoge gehaltes geproduceerd. Productie en isolatie van TAG zal worden getest in verschillende stammen gekweekt in eenvoudige media en substraten. Het project wordt uitgevoerd door een projectteam bestaande uit wetenschappers/docenten van de HU/iLab en de biotech startup Microfuel Innovations B.V.
In Nederland wordt flink nagedacht over mobiliteitsconcepten waarmee problemen als emissies, fijnstof, parkeerdruk en congestie kunnen worden teruggedrongen. Vooral in stedelijke omgevingen is hier veel aandacht voor om de leefbaarheid en toegankelijkheid binnen deze gebieden te vergroten. Lichte elektrische voertuigen (LEVs) zijn klein, schoon en wendbaar en kunnen in de mobiliteitstransitie die dit toekomstbeeld vereist een prominente rol spelen. Één van de vereisten voor deze transitie is de mogelijkheid om deze voertuigen – van monowheels tot microcars – veilig en toegankelijk te kunnen laden, zodat zij hun functie als duurzame vervanger van traditionelere vervoersmiddelen met verbrandingsmotor kunnen vervullen. Hiervoor is een wijdverspreid netwerk van laadmogelijkheden nodig. Voor LEVs is dit in theorie niet zo heel moeilijk, omdat de accu's van deze voertuigen zowel via (publieke) laadpalen als via een willekeurig stopcontact zouden kunnen worden opgeladen. Gemak dient de mens, zou je dus zeggen? Echter, bestaande laadpalen zijn hiervoor op dit moment niet beschikbaar. Daarnaast hebben veiligheidsrisicoanalisten de noodklok geluid over de veiligheidsrisico's van het laden van LEV-accu's. Zij vrezen dat door onjuist hanteren of het laten vallen of stoten van de accupakketten de brandveiligheid van de accu's niet te garanderen en controleren is; een probleem dat de brandweer publiekelijk onderschrijft. In “LEV: Laad Maar!” duiken vier praktijkpartners in deze nieuwe problematiek en beantwoorden we de vraag: Middels welke laad technologieën kan het veilig en toegankelijk laden van LEVs in Nederland worden verbeterd? Het doel is om een handreiking voor techniekontwikkelaars en veiligheidsadviseurs te ontwikkelen op basis waarvan keuzes over de laadsystemen voor LEVs kunnen worden ondersteund. Hiertoe worden in dit project literatuuronderzoek, interviews en studentenprojecten met betrekking tot optimale ontwikkeling van laadinfrasystemen uitgevoerd. De resultaten zullen worden gepubliceerd in factsheets, vakpublicatie(s) en presentatie(s) voor de doelgroep, en worden opgenomen in het onderwijs op de HAN over laadinfra en (LEV-)accusystemen.
