Deze publicatie is tot stand gekomen in het kader van een updateproject, waarbij een groot aantal technische voorlichtingspublicaties worden aangepast aan de huidige stand der techniek. Hierbij heeft een nauwe samenwerking plaatsgevonden tussen de in de stuurgroep vermelde partijen. Deze publicatie "MIG/MAG lassen en zijn varianten" is een update van de publicatie "MIG/MAG lassen", welke is geschreven door de heer J.D. Roeters van Lennep en in 1986 is uitgegeven door het Nederlands Instituut voor Lastechniek. De geüpdate publicatie is, evenals de andere in dit updateproject vervaardigde en uitgegeven publicaties, gratis te downloaden vanaf de websites "www.verbinden-online.nl", "www.dunneplaat-online.nl" en via de websites van de deelnemende organisaties.
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Voor u ligt de voorlichtingspublicatie "Onder poeder lassen". Dit blad is een update van het NIL-voorlichtingsblad "Onder poeder lassen" dat in 1988 is opgesteld als onderdeel van het gelijknamige onderzoeksproject dat uitgevoerd is onder supervisie van het Nederlands Instituut voor Lastechniek. Daar er in de periode tussen verschijning van de eerste uitgave en nu een aantal belangrijke ontwikkelingen op het gebied van het onder poeder lassen is geweest, was een aanpassing aan de huidige stand der techniek noodzakelijk. De Nederlandse overheid heeft geld ter beschikking gesteld om een aantal verouderde voorlichtingspublicaties aan te passen aan de stand der techniek; de FME heeft de coördinatie daarvan op zich genomen. Voor de aanpassing van deze publicatie heeft zij het NIL de opdracht gegeven. De oude voorlichtingspublicatie vormt de basis van deze update, zodat verwijzingen naar geraadpleegde literatuur aanvullend aan de oude publicatie zijn.
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The present study deals with the numerical modelling of hybridlaminated composites, which can be proved especially useful in theengineering and maintenance of advanced aerospace primary structures. Thelamina is comprised of continuous carbon fibers, thermosetting epoxypolymer matrix, as well as carbon nanostructures, such as graphene orcarbon nanotubes, inclusions. Halpin-Tsai equations combined with resultsobtained from nanomechanical analysis are employed in order to evaluatethe elastic properties of the carbon nanostructure/polymer matrix. Then, theobtained elastic properties of the hybrid matrix are used to calculate theorthotropic macro-mechanical properties of the unidirectional compositelamina. A hybrid composite plate is modelled as a 2D structure via theutilization of 4-node, quadrilateral, stress/displacement shell finite elementswith reduced integration formulation. The convergence and analysisaccuracy are tested. The mechanical performance of the hybrid compositesis investigated by considering specific configurations and applyingappropriate loading and boundary conditions. The results are compared withthe corresponding ones found in the open literature, where it is possible.
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Deze publicatie is gemaakt in het kader van het project "Proceskeuze voor de fabricage van producten met hoge nauwkeurigheidseisen te vervaardigen in kleine series" en verschijnt tezamen met de publicatie "Een vergelijking van het laserlassen met conventionele lastechnieken voor kleine series producten". Het doel van deze publicatie is het ondersteunen van de ontwerper en de werkvoorbereider bij het kiezen van het optimale omvormproces wat betreft technologie en economie. Hierbij dient niet alleen te worden uitgegaan van de eisen die aan het eindproduct gesteld worden, maar er dient ook rekening te worden gehouden met de eisen die opvolgende bewerkingen, zoals lasprocessen aan halffabrikaten stellen.
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BackgroundHigh-flow nasal oxygen (HFNO) is increasingly used in patients with acute hypoxemic respiratory failure. It is uncertain whether a broadened Berlin definition of acute respiratory distress syndrome (ARDS), in which ARDS can be diagnosed in patients who are not receiving ventilation, results in similar groups of patients receiving HFNO as in patients receiving ventilation.MethodsWe applied a broadened definition of ARDS in a multicenter, observational study in adult critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), wherein the requirement for a minimal level of 5 cm H2O PEEP with ventilation is replaced by a minimal level of airflow rate with HFNO, and compared baseline characteristics and outcomes between patients receiving HFNO and patients receiving ventilation. The primary endpoint was ICU mortality. We also compared outcomes in risk for death groups using the PaO2/FiO2 cutoffs as used successfully in the original definition of ARDS. Secondary endpoints were hospital mortality; mortality on days 28 and 90; need for ventilation within 7 days in patients that started with HFNO; the number of days free from HFNO or ventilation; and ICU and hospital length of stay.ResultsOf 728 included patients, 229 patients started with HFNO and 499 patients with ventilation. All patients fulfilled the broadened Berlin definition of ARDS. Patients receiving HFNO had lower disease severity scores and lower PaO2/FiO2 than patients receiving ventilation. ICU mortality was lower in receiving HFNO (22.7 vs 35.6%; p = 0.001). Using PaO2/FiO2 cutoffs for mild, moderate and severe arterial hypoxemia created groups with an ICU mortality of 16.7%, 22.0%, and 23.5% (p = 0.906) versus 19.1%, 37.9% and 41.4% (p = 0.002), in patients receiving HFNO versus patients receiving ventilation, respectively.ConclusionsUsing a broadened definition of ARDS may facilitate an earlier diagnosis of ARDS in patients receiving HFNO; however, ARDS patients receiving HFNO and ARDS patients receiving ventilation have distinct baseline characteristics and mortality rates.Trial registration: The study is registered at ClinicalTrials.gov (identifier NCT04719182).
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Objective: To construct the underlying value structure of shared decision making (SDM) models. Method: We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz’s value theory to define values in SDM and to investigate value relations. Results: We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals’ (HCPs) and patients’ skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients’ autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. Conclusion: SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients’ Self-Direction. Practice implications: This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients’ values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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The Internet and computers increasingly determine our daily lives. This goes for almost everyone in the Netherlands. Still, it is mostly teenagers who are well informed on how to use all the possibilities of new technologies. They are building a digital world of their own that parents usually know very little about. This booklet intends to inform teachers, parents and other interested parties on what teenagers are actually doing online and how important it is to keep abreast of the new developments that the Internet and computers bring into their world. On the basis of research into these issues in the Netherlands and abroad we attempt to indicate what the digital world of teenagers looks like and how it differs from that of grown-ups. What do they do, exactly, and why? We also look into teenagers’ ICT behaviour and into dangers and abuse of the Internet. Moreover we provide tips for parents and teachers on how to handle certain phenomena. This book does not pretend to provide an exhaustive overview of the digital world of teenagers. It is focused on some important characteristics and parts of that world. It reports on research of the INHOLLAND Centre for eLearning into various aspects of ICT behaviour among teenagers. The research was undertaken in the spring of 2006, focusing mainly on texting, networking, gaming, dangers and abuse on the Internet and the digital relation between school and the home. Ultimately we are especially concerned with the question of what teenagers really learn in their digital world, and how education can profit. This book also addresses that issue.
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This chapter describes the growing influence of point-of-care diagnostics (POCD) on the daily lives of citizens, their immediate families, and healthcare providers. With a view to the future, the most important contemporary developments in this field are discussed, such as noninvasive sensor technology in the diagnostic process, practical examples of point-of-care diagnostics (POCD), including the quantify-self movement and infrared technology. Cost-effectiveness, adoption of POCD, and the contribution of POCD innovations to self-management and health literacy are also discussed. Developments in which deep learning and artificial intelligence are used to make the diagnostic results more reliable are also conferred, such as the development of point-of-care Internet diagnostics. The discussion of professional advice dilemma’s in POCD, the patient’s appreciation of POCD, and ethical and philosophical considerations conclude this chapter.
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BACKGROUND: The SpO2/FiO2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO2/FiO2 for mortality in patients with ARDS due to COVID-19.METHODS: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality.RESULTS: In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO2/FiO2 on day 1 had no prognostic value. The SpO2/FiO2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO2/FiO2 on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO2/FiO2 and the PaO2/FiO2 calculated from SpO2/FiO2 were strongly correlated (Spearman's r = 0.79).CONCLUSIONS: In this cohort of patients with ARDS due to COVID-19, the SpO2/FiO2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO2/FiO2 is a useful metric for risk stratification in invasively ventilated COVID-19 patients.
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